[Federal Register Volume 79, Number 4 (Tuesday, January 7, 2014)]
[Notices]
[Pages 832-834]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-31590]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Proposed Collection: 
Public Comment Request

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice.

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SUMMARY: In compliance with the requirement for opportunity for public 
comment on proposed data collection projects (Section 3506(c)(2)(A) of 
the Paperwork Reduction Act of 1995), the Health Resources and Services 
Administration (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 Information Collection Request must be received 
within 60 days of this notice.

ADDRESSES: Submit your comments to [email protected] or mail the HRSA 
Information Collection Clearance Officer, Room 10-29, Parklawn 
Building, 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 [email protected] or call 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 
utilized by the National Health Service Corps (NHSC) Scholarship 
Program, the NHSC Students to Service Loan Repayment Program (S2S LRP), 
and the Native Hawaiian Health Scholarship Program (NHHSP).
    OMB No.: 0915-0146--Revision.
    Abstract: Administered by HRSA's Bureau of Clinician Recruitment 
and Service (BCRS), 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 medically 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 
providing 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 the selection of the best qualified candidates for 
these competitive awards, and to monitor participants' enrollment in 
school or in postgraduate training.
    Although some program forms vary (see program-specific burden 
charts below), general forms include: The 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 
(formerly the Deferment Request Form applicable for S2S 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 of the program.
    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

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applicants that will enable BCRS to make determinations about the 
competitive awards.
    Likely Respondents: Qualified students who are pursuing primary 
care health professions education and training and are interested in 
working with underserved populations.
    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 Information Collection Request are summarized in the table below.
    Total Estimated Annualized burden hours:

NHSC Scholarship Program

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                                                                                      Average
                                     Number of       Number of         Total        burden per     Total burden
            Form name               respondents    responses per     responses     response  (in       hours
                                                    respondent                        hours)
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NHSC Scholarship Program                    1800               1            1800            2.00            3600
 Application....................
Letters of Recommendation.......            1800               2            3600             .50            1800
Authorization to Release                    1800               1            1800             .10             180
 Information....................
Acceptance/Verification of Good             1800               1            1800             .25             450
 Standing Report................
Receipt of Exceptional Financial             200               1             200             .25              50
 Need Scholarship...............
Data Collection Worksheet.......             400               1             400            1.00             400
Post Graduate Training                       100               1             100             .50              50
 Verification Form..............
Enrollment Verification Form....             600               2            1200             .50             600
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    Total.......................            1100  ..............            1700  ..............            1050
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Verification of Disadvantaged                300               1             300             .25              75
 Background Status..............
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    Total.......................            7700  ..............            9500  ..............            6155
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    The annual estimate of burden for participants/schools/residency 
programs is as follows:

NHSC Students to Service Loan Repayment Program

Native Hawaiian Health Scholarship Program

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                                                                                      Average
                                     Number of       Number of         Total        burden per     Total burden
           Form name*               respondents    responses per     responses     response  (in       hours
                                                    respondent                        hours)
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Native Hawaiian Health                       250               1             250            1.00          250.00
 Scholarship Program Application
 (includes Forms A-E: Applicant
 Resume Instructions and
 Guidelines; NHHSP Questionnaire
 and Narrative Statement;
 Conflicting Federal Service
 Memo; Debarment, Suspension,
 Disqualification and Related
 Matters Certification; and
 Delinquent Federal Debt).......
NHSC Students to Service Program             100               1             100            2.00          200.00
 Application....................
Letters of Recommendation.......             100               2             200             .50          100.00
Authorization to Release                     100               1             100             .10           10.00
 Information....................
Acceptance/Verification of Good              100               1             100             .25           25.00
 Standing Report................
Receipt of Exceptional Financial               4               1               4             .25            1.00
 Need Scholarship...............
Verification of Disadvantaged                 25               1              25             .25            6.25
 Background Status..............
Post Graduate Training                       150               1             150             .50           75.00
 Verification Form..............
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    Total.......................             579  ..............             679  ..............          417.25
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Letters of Recommendation                    250               2             500             .25          125.00
 (includes Forms H and I:
 Academic Faculty/Advisor
 Evaluation of Applicant and
 Employer Evaluation of
 Applicant).....................
Authorization to Release                     250               1             250             .25           62.50
 Information (Form F)...........
Acceptance/Verification of Good               30              12             360             .25           90.00
 Standing Report (includes Form
 G: Course Curriculum Worksheet)
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    Total.......................             780  ..............            1360  ..............          527.50
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*Please note that the forms listed above account for supporting documentation which may be uploaded as part of
  the application or associated with the supplemental forms.

    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

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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.

    Dated: December 30, 2013.
Bahar Niakan,
Director, Division of Policy and Information Coordination.
[FR Doc. 2013-31590 Filed 1-6-14; 8:45 am]
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