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OMB Control No: 0906-0073	ICR Reference No: 202508-0906-003
Status: Received in OIRA	Previous ICR Reference No: 202209-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Bureau of Health Workforce (BHW) Program Specific Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 08/21/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2025
Responses	340	2,392
Time Burden (Hours)	4,760	38,979
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	340	2,392	-2,052
Annual Time Burden (Hours)	4,760	38,979	-34,219
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: HRSA will move the BHW Program Specific Data Form to another ICR that reports data outcomes post grant award. As for average burden per response for the SDS Program Specific Form, SDS program staff conducted burden testing performed by eight grantees regarding the format, content of data to be collected, and time to complete the application and report. The SDS Program Specific Form was reduced from sixteen sections to seven sections. The program staff calculated the time for completion of the revised form at 14 hours based upon program experience and past grant recipient comments. This is a reduction from 31 hours in the prior ICR.

Annual Cost to Federal Government: $189,323

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. No

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. No

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: Laura Cooper 301 443-2126 lcooper@hrsa.gov