[Federal Register Volume 79, Number 56 (Monday, March 24, 2014)]
[Notices]
[Pages 16013-16015]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-06337]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Submission to OMB for 
Review and Approval; Public Comment Request

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice.

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SUMMARY: In compliance with Section 3507(a)(1)(D) of the Paperwork 
Reduction Act of 1995, the Health Resources and Services Administration 
(HRSA) has submitted an Information Collection Request (ICR) to the 
Office of Management and Budget (OMB) for review and approval. Comments 
submitted during the first public review of this ICR will be provided 
to OMB. OMB will accept further comments from the public during the 
review and approval period.

DATES: Comments on this ICR should be received within 30 days of this 
notice.

ADDRESSES: Submit your comments, including the Information Collection 
Request Title, to the desk officer for HRSA, either by email to [email protected] or by fax to 202-395-5806.

FOR FURTHER INFORMATION CONTACT: To request a copy of the clearance 
requests submitted to OMB for review, email the HRSA Information 
Collection Clearance Officer at [email protected] or call (301) 443-
1984.

SUPPLEMENTARY INFORMATION: 
    Information Collection Request Title: Application and Other Forms 
utilized by the National Health Service Corps Scholarship Program, 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 Clinician Recruitment 
and Service (BCRS), the National Health Service Corps (NHSC) 
Scholarship Program (SP), NHSC Students to Service Loan Repayment 
Program (S2S LRP),

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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 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.
    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 and 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 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 ICR 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...............
Verification of Disadvantaged                300               1             300             .25              75
 Background Status..............
                                 -------------------------------------------------------------------------------
    Total.......................  ..............  ..............            9500  ..............            6155
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    The annual estimate of burden for participants/schools/residency 
programs is as follows:

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                                                     Number of                    Average burden
            Form name                Number of     responses per       Total       per response    Total burden
                                    respondents     respondent       responses      (in hours)         hours
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Data Collection Worksheet.......             400               1             400            1.00             400
Post Graduate Training                       200               1             200             .50             100
 Verification Form..............
Enrollment Verification Form....             600               2            1200             .50             600
                                 -------------------------------------------------------------------------------
    Total.......................  ..............  ..............            1800  ..............            1100
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                                 NHSC Students to Service Loan Repayment 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 Students to Service Program             100               1             100            2.00          200
 Application....................
Letters of Recommendation.......             100               2             200             .50          100
Authorization to Release                     100               1             100             .10           10
 Information....................

[[Page 16015]]

 
Acceptance/Verification of Good              100               1             100             .25           25
 Standing Report................
Receipt of Exceptional Financial               4               1               4             .25            1
 Need Scholarship...............
Verification of Disadvantaged                 25               1              25             .25            6.25
 Background Status..............
Post Graduate Training                       150               1             150             .50           75
 Verification Form..............
                                 -------------------------------------------------------------------------------
    Total.......................  ..............  ..............             679  ..............          417.25
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                                   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
 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).......
Letters of Recommendation                    250               2             500             .25          125
 (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
 Standing Report (includes Form
 G: Course Curriculum Worksheet)
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    Total.......................  ..............  ..............            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.


    Dated: March 18, 2014.
Jackie Painter,
Deputy Director, Division of Policy and Information Coordination.
[FR Doc. 2014-06337 Filed 3-21-14; 8:45 am]
BILLING CODE 4165-15-P