Corps Community Month Event Form

ICR 201605-0915-004

OMB: 0915-0362

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
206735 Modified
ICR Details
0915-0362 201605-0915-004
Historical Active 201304-0915-003
HHS/HSA 19281
Corps Community Month Event Form
Extension without change of a currently approved collection   No
Regular
Approved without change 07/19/2016
Retrieve Notice of Action (NOA) 05/26/2016
  Inventory as of this Action Requested Previously Approved
07/31/2019 36 Months From Approved 07/31/2016
600 0 600
30 0 30
0 0 0

The goals of Corps Community Month, formerly Corps Community Day encompass the following: increase awareness of the National Health Service Corps (NHSC) to potential applicants and the greater primary health community; create a sense of community and connectedness among NHSC program participants, alumni, partners and staff; and underscore the NHSC’s role in bringing primary health care services to the nation’s neediest communities. Current program participants, alumni, NHSC Ambassadors, NHSC clinical sites, primary care organizations, and professional associations plan events and report the details of their events to BHW so that they can be added to a map of events. In order to avoid duplication of effort, eliminate confusion regarding allowable event dates, avoid data entry errors, and implement a brief post-event satisfaction survey, BHW would like to implement a standard form that event planners will use to report to BHW. The fillable form will be available online.

PL: Pub.L. 111 - 148 254 Name of Law: Affordable Care Act of 2010
  
None

Not associated with rulemaking

  81 FR 56 03/23/2016
81 FR 100 05/24/2016
No

1
IC Title Form No. Form Name
Corps Community Day Event Forms 1, 2 Event Planning Form ,   Satisfaction Form

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 600 600 0 0 0 0
Annual Time Burden (Hours) 30 30 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$3,232
No
No
Yes
No
No
Uncollected
Elyana Bowman 301 443-3983 enadjem@hrsa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/26/2016


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