Supporting Statement_NHSC_Follow-Up Form_2010_FINAL

Supporting Statement for National Health Service Corps Loan Repayment Program

Health Resources and Services Administration

A. JUSTIFICATION

1. Circumstances of Information Collection

This is a request for Office of Management and Budget (OMB) approval of a data collection form for potential applicants for the Health Resources and Services Administration’s (HRSAs) National Health Service Corps (NHSC) Loan Repayment Program (LRP) and Scholarship Program (SP). The current NHSC regulations are found at 42 CFR Part 62.

Under the NHSC/LRP and SP, the Department of Health and Human Services (HHS) enters into contracts with selected primary care health professionals who agree to provide full-time primary health services in designated health professional shortage areas (HPSAs). In return for these health services, HHS agrees to repay up to $60,000 per year toward the health professionals' qualifying educational loans. Qualifying educational loans are loans from Government or commercial lending institutions for actual costs for tuition, reasonable educational expenses, and reasonable living expenses for graduate and undergraduate education.

Through the Affordable Care Act, the NHSC/LRP and SP has received additional funding. In order to recruit new applicants to the Programs, to fulfill increasing recruitment goals, NHSC is actively marketing the Programs to currently practicing clinicians as well as students in health profession training programs.

2. Purpose and Use of Information

Information Follow-up Form

The NHSC is committed to improving the health of the Nation’s underserved by uniting communities in need with caring health professionals and by supporting communities’ efforts to build better systems of care.

The NHSC Information Follow-up Form, which NHSC will use when exhibiting at national and regional conferences as well as when presenting on campuses to health profession students, is an optional form that a health profession student, licensed clinician, faculty member, or clinical site administrator can fill out. Individuals who submit the form to NHSC, may ask questions and/or sign up to receive periodic program updates and other general information regarding opportunities with the NHSC via email. An individual is free to discontinue receiving communication from NHSC at anytime by emailing NHSCupdate@hrsa.gov. Completed forms will contain information such as, the names of the individuals, their email address(es), their city and state, the organization where they are employed (or the school which they attend), the year they intend to graduate (if applicable), how they heard about NHSC, which NHSC programs they are interested in, etc. Assistance in completing the form will be given by the BCRS staff person (or BCRS representative) who is present at the event.

3. Use of Improved Information Technology

The NHSC Information Follow-up Form is a paper based form.

4. Efforts to Avoid Duplication

The information requested in the Information Follow-up Form is specific to the applicant and unique to the NHSC.

5. Involvement of Small Entities

The forms will not have a significant impact on small entities.

6. Consequences if Information is Collected Less Frequently

The follow-up process for the NHSC/LRP and SP applicants is necessary to keep a potential applicant pool that is kept informed of the benefits of the NHSC and their potential membership into the Corps. Without collecting information of those who the NHSC meets at marketing and recruitment events, the Corps is missing opportunity for future applicants.

7. Consistency with the Guidelines in 5 CFR 1320.5 (d)(2)

This information collection is consistent with 5 CFR 1320.5 (d)(2).

8. Consultation Outside the Agency

The notice required in 5 CFR 1320.8(d) was published in the Federal Register on September 7, 2010, Vol.75, No. 172, page 54342. The 30 day notice was published in the Federal Register on October 28, 2010, Vol.75, No. 208, page 66380. No comments were received.

9. Remuneration of Respondents

Respondents will receive no remuneration.

10. Assurance of Confidentiality

As no Personal Identification Information will be collected on this form, there is no need for an Assurance of Confidentiality.

11. Questions of a Sensitive Nature

There is no data of sensitive nature collected on this form.

12. Estimates of Annualized Hour Burden

The estimates of reporting burden are as follows:

Form	Number of Respondents	Responses per Respondent	Total Responses	Hours per Response	Total Burden Hours	Hour Cost	Total Hour Cost
Information Follow-up Form	2400	1	2400	.025 (90 seconds)	60	$20	$1,200
Total	2400	1	2400	.025 (90 seconds)	60	$20	$1,200

Basis for estimates:

Based on the FY10 exhibit and presentation schedule, NHSC could have gathered information from 2,400 individuals. Using this as a guide for future years, the estimated annual burden is as shown above.

13. Estimates of Annualized Cost Burden to Respondents

There are no capital or start-up costs to respondents. There are no operation or maintenance costs to lenders; all information is maintained for usual business purposes.

14. Estimates of Annualized Cost to the Government

The data entry of collected forms is minimal. One FTE at the GS-5 level, who spends 15% of her time inputting the contact information is a cost of $27,431 (15% of $27,431 = $4,115).

15. Changes in Burden

This is a new request.

16. Time Schedule, Publication and Analysis Plans

There are no plans for tabulation, statistical analysis, or publication of data requested.

17. Exemption for Display of Expiration Date

No exemption is requested.

18. Certifications

This project fully complies with the requirements in 5 CFR 1320.5(d)(2).