Agency Information Collection Activities: Proposed Collection: Public Comment Request Information Collection Request Title: Application and Other Forms Used by the National Health Service Corps (NHSC) Scholarship Program (SP), the NHSC Students to Service Loan Repayment Program (S2S LRP), and the Native Hawaiian Health Scholarship Program (NHHSP), OMB No. 0915-0146-Revision
In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, HRSA announces plans to submit...
Health Resources and Services Administration (HRSA), Department of Health and Human Services.
ACTION:
Notice.
SUMMARY:
In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, HRSA announces plans to submit an Information Collection Request (ICR), described below, to the Office of Management and Budget (OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the public regarding the burden estimate, below, or any other aspect of the ICR.
DATES:
Comments on this ICR should be received no later than May 8, 2020.
ADDRESSES:
Submit your comments to
paperwork@hrsa.gov
or mail the HRSA Information Collection Clearance Officer, Room 14N136B, 5600 Fishers Lane, Rockville, MD 20857.
FOR FURTHER INFORMATION CONTACT:
To request more information on the proposed project or to obtain a copy of the data collection plans and draft instruments, email
paperwork@hrsa.gov
or call Lisa Wright-Solomon, the HRSA Information Collection Clearance Officer at (301) 443-1984.
SUPPLEMENTARY INFORMATION:
When submitting comments or requesting information, please include the information request collection title for reference.
Information Collection Request Title:
Application and Other Forms Used by NHSC Scholarship Program (SP), the NHSC Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program.
OMB No. 0915-0146—Revision
Abstract:
Administered by HRSA's Bureau of Health Workforce, the NHSC SP, NHSC S2S LRP, and the 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 medically underserved communities located in federally designated Health Professional Shortage Areas 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 information from program applications, forms, and supporting documentation is used to select the best qualified candidates for these competitive awards, and to monitor program participants' enrollment in school, postgraduate training, and compliance with program requirements.
Although some program forms vary from program to program (see program-specific burden charts below), required forms generally include: A program application, academic and non-academic letters of recommendation, the authorization to release information, and the acceptance/verification of good standing report. Additional forms for the NHSC SP include the data collection worksheet, which is completed by the educational institutions of program participants; the post-graduate training verification form (applicable for NHSC S2S LRP participants), which is completed by program participants and their residency director; and the enrollment verification form, which is completed by program participants and the educational institution for each academic term. For this ICR, the NHHSP program proposes to add 3 new forms including the scholar enrollment verification, change in program curriculum and graduation documentation forms. These forms will be completed by the grantee on behalf of the participant and the educational institution to verify the participant's enrollment status for each academic term, to provide notice of any change in the participant's program curriculum, and to verify that NHHSP has met its financial obligation to pay tuition and related fees or to hold additional funds to cover any tuition balance or fees on the participant's student account.
Need and Proposed Use of the Information:
The NHSC SP, S2S LRP, and NHHSP applications, forms, and supporting documentation are used to collect necessary information from applicants that enable HRSA to make selection determinations for the competitive awards and monitor compliance with program requirements.
( printed page 13663)
Likely Respondents:
Qualified students who are pursuing education and training in primary care health professions and are interested in working in health professional shortage areas.
Burden Statement:
Burden in this context means the time expended by persons to generate, maintain, retain, disclose or provide the information requested. This includes the time needed to review instructions; to develop, acquire, install, and utilize technology and systems for the purpose of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; to train personnel and to be able to respond to a collection of information; to search data sources; to complete and review the collection of information; and to transmit or otherwise disclose the information. The total annual burden hours estimated for this ICR are summarized in the table below.
Total Estimated Annualized Burden Hours:
NHSC Scholarship Program Application
Form name
Number of
respondents
Number of
responses
per
respondent
Total
responses
Average
burden per
response
(in hours)
Total burden hours
NHSC Scholarship Program Application
1,889
1
1,889
2.00
3,778.00
Letters of Recommendation
1,889
2
3,778
1.00
3,778.00
Authorization to Release Information
1,889
1
1,889
.10
188.90
Acceptance/Verification of Good Standing Report
1,889
1
1,889
.25
472.25
Verification of Disadvantaged Background Status
547
1
547
.25
136.75
Total
* 1,889
9,992
8,353.9
* Certain documents are submitted by a subset of respondents consistent with program requirements.
NHSC Awardees/Schools/Post Graduate Training Programs/Sites
Form name
Number of
respondents
Number of
responses
per
respondent
Total
responses
Average
burden per
response
(in hours)
Total burden hours
Data Collection Worksheet
400
1
400
1.00
400
Post Graduate Training Verification Form
100
1
100
.50
50
Enrollment Verification Form
600
2
1,200
.50
600
Total
* 600
1,700
1,050
*
Please note that the same group of respondents may complete each form as necessary.
NHSC Students To Service Loan Repayment Program Application
Form name
Number of
respondents
Number of
responses
per
respondent
Total
responses
Average
burden per
response
(in hours)
Total burden hours
NHSC Students to Service Loan Repayment Program Application
200
1
200
2.00
400
Letters of Recommendation
200
2
400
1.00
400
Authorization to Release Information
200
1
200
.10
20
Acceptance/Verification of Good Standing Report
200
1
200
.25
50
Verification of Disadvantaged Background Status
70
1
70
.25
17.5
Post Graduate Training Verification Form
150
1
150
.50
75
Total
* 150
1,220
962.5
*
Certain documents are submitted by a subset of respondents consistent with program requirements.
Native Hawaiian Health Scholarship Program Application
Form name
Number of
respondents
Number of
responses
per
respondent
Total
responses
Average
burden per
response
(in hours)
Total burden hours
Native Hawaiian Health Scholarship Program Application
310
1
310
2.00
620.0
Letters of Recommendation
310
2
620
.25
155.0
Authorization to Release Information
310
1
310
.25
77.5
Acceptance/Verification of Good Standing Report
30
1
30
.25
7.5
Scholar Enrollment Verification Form
30
7.5
225
0.50
112.5
Change in Program Curriculum Form
30
2
60
.25
15.0
NHHSP Graduation Documentation Form
30
1
30
0.25
7.5
( printed page 13664)
Total
* 310
1,585
995
*
Certain documents are submitted by a subset of respondents consistent with program requirements.
HRSA specifically requests comments on (1) the necessity and utility of the proposed information collection for the proper performance of the agency's functions, (2) the accuracy of the estimated burden, (3) ways to enhance the quality, utility, and clarity of the information to be collected, and (4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden.
Use this for formal legal and research references to the published document.
85 FR 13662
Web Citation
Suggested Web Citation
Use this when citing the archival web version of the document.
“Agency Information Collection Activities: Proposed Collection: Public Comment Request Information Collection Request Title: Application and Other Forms Used by the National Health Service Corps (NHSC) Scholarship Program (SP), the NHSC Students to Service Loan Repayment Program (S2S LRP), and the Native Hawaiian Health Scholarship Program (NHHSP), OMB No. 0915-0146-Revision,” thefederalregister.org (March 9, 2020), https://thefederalregister.org/documents/2020-04762/agency-information-collection-activities-proposed-collection-public-comment-request-information-collection-request-title.