View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0915-0146
ICR Reference No:
202305-0915-001
Status:
Active
Previous ICR Reference No:
202006-0915-004
Agency/Subagency:
HHS/HSA
Agency Tracking No:
Title:
The National Health Service Corps Scholarship Program, Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
07/25/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/09/2023
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2026
36 Months From Approved
07/31/2023
Responses
18,110
0
14,347
Time Burden (Hours)
14,705
0
11,289
Cost Burden (Dollars)
0
0
0
Abstract:
Administered by HRSA’s Bureau of Health Workforce (BHW), the National Health Service Corps (NHSC) Scholarship Program (SP), NHSC Students to Service Loan Repayment Program (S2S LRP), and the Native Hawaiian Health Scholarship Program (NHHSP), provide scholarships or loan repayment to qualified students who are pursuing primary care health professions education and training. In return, students agree to provide primary health care services in underserved communities located in federally designated Health Professional Shortage Areas (HPSAs) once they are fully trained and licensed health professionals. Awards are made to applicants who demonstrate the greatest potential for successful completion of their education and training as well as commitment to provide primary health care services to communities of greatest need. The program applications, forms, and supporting documentation are used to collect necessary information from applicants and participants that will facilitate in the selection of the best qualified candidates for these competitive awards, and to monitor participants’ enrollment in school or in postgraduate training.
Authorizing Statute(s):
US Code:
42 USC Sect. 338B 254d(i), l, 3331(i)
Name of Law: National Health Service Corps
US Code:
42 USC Sect. 338A 254d(i), l, m-q
Name of Law: National Health Service Corps
US Code:
42 USC 11709
Name of Law: The Native Hawaiian Health Care Improvement Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
88 FR 9525
02/14/2023
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 27902
05/05/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
20
IC Title
Form No.
Form Name
NHHSP Acceptance/Verification of Good Standing Report
4C
NHHSP Acceptance Verification of Good Standing Form
NHHSP Authorization to Release Information
4B
NHHSP Authorization to Release Information
NHHSP Change in Program Curriculum Form
4F
NHHSP Change in Program Curriculum Form
NHHSP Graduation Documentation Form
4G
NHHSP Graduation Documentation Form
NHHSP Letters of Reccomendation
4H
NHHSP Letters of Reccomendation
NHHSP Letters of Recommendation
4-2
NHHSP Instructions - Letters of Recommendation.pdf
NHHSP Scholar Enrollment Verification Form
4E
NHHSP Scholar Enroll Verification Form
NHSC SP Authorization to Release Information
1C
Authorization to Release Information
NHSC SP Awardees Schools – Post Graduate Training Verification Form
2D
Post Graduate Training Verification
NHSC SP Awardees Schools – Data Collection Worksheet
2C
Data Collection Worksheet Form
NHSC SP Awardees Schools – Enrollment Verification Form
2E
Enrollment Verification Form
NHSC SP Letters of Recommendation
1B
Letters of Recommendation
NHSC SP – Acceptance/Verification of Good Standing Report
1D
NHSC SP-Acceptance Verification of Good Standing Report
NHSC SP – Verification of Disadvantaged Background
2B
Verification of Disadvantaged Background Status
NHSC Scholarship Program Application
1A
NHSC Scholarship Program Application
NHSC Students to Service Repayment Program Application
3-1
NHSC S2S LRP Application Screenshots.docx
Native Hawaiian Health Scholarship Program Application
4A
NHHSP Program Application (User Guide)
S2S LRP – Authorization to Release Information
3C
NHSC S2S LRP Authorization to Release Information Form.pdf
S2S LRP - Letters of Recommendation
3B-Preceptor, 3B-Instructions
Letters of Recommendations-Instructions
,
3B
S2S LRP - Verification of Disadvantaged Background
3E
Verification of Disadvantaged Background Status
S2S LRP – Acceptance/Verification of Good Standing Report
3D
Acceptance Verification of Good Standing Form
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
18,110
14,347
0
4,383
-620
0
Annual Time Burden (Hours)
14,705
11,289
0
3,571
-155
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
In reviewing the application and forms for this request, the NHSC SP, NHSC S2S LRP and NHHSP programs anticipate an increase in the number of interested applicants. This resulted in an overall increase in the burden of this information collection from 11,286.40 to 14,703.90 hours.
Annual Cost to Federal Government:
$601,288
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Tierra Moore 301 443-0496 tmoore@hrsa.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/09/2023
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