SSA-SDS FINAL 3-3-17doc

Scholarships for Disadvantaged Students

Application Program Specific Form

Supporting Statement

0915-0149 Revision

1. Justification

1. Circumstances of Information Collection

This is a request to OMB for continued approval for the Scholarships for Disadvantaged Students (SDS) program Information Collection Request (OMB No. 0915- 0149). This submission is a revision to the existing package.

The SDS program is authorized by sections 725(f)(2) and 737(h)(2) of the Public Health Service (PHS) Act, as amended by the Disadvantaged Minority Health Improvement Act of 1990 (Public Law 101-527), as amended and renumbered by the Health Professions Education Extension Amendments of 1992 (Public Law 102-408), and amended by the Health Professions Education Partnerships Act of 1998 (Public Law 105-392, 42 U.S.C. 293a). The purpose of the SDS program is to promote diversity among health profession students and practitioners by providing funds to eligible schools for the purpose of providing scholarships to full-time financially needy students from disadvantaged backgrounds enrolled in health profession and nursing programs.

To qualify for participation in the SDS program, a school must carry out a program for recruiting and retaining students from disadvantaged backgrounds, including students who are members of racial and ethnic minority groups (section 737(d)(1)(B) of the PHS Act). A school must meet the eligibility criteria to demonstrate that the program has achieved success based on the number and/or percentage of disadvantaged students who graduate from the school. In awarding SDS funds to eligible schools, funding points must be given to schools based on the proportion of graduate students practicing in primary care, the proportion of full-time underrepresented minority students, and the proportion of graduate working in medically underserved communities (section 737(c) of the PHS Act).

Schools that are eligible for the SDS program are schools of medicine, dentistry, osteopathic medicine, pharmacy, optometry, podiatric medicine, and veterinary medicine, schools of nursing, public health, allied health, chiropractic, and graduate programs in clinical psychology, clinical social work, professional counseling, marriage and family therapy, and physician assistants training.

2. Purpose and Use of Information

SDS Application

Information collected for the SDS application is needed by the Department to determine whether applicant schools meet the requirements of enabling legislation, to determine eligibility for program participation, and to establish priority points for funding. Applicant schools are requested to complete an application for each discipline or program. Data are provided on numbers of full-time student enrollment and its’ racial/ethnicity data, disadvantaged full-time enrollment by class year, full-time students graduated, full-time disadvantaged students graduated, and full-time graduates serving in Medically Underserved Communities. Numbers of full-time graduates serving primary care must be provided only for schools of medicine, osteopathic medicine, dentistry, nursing (graduate degree program), physician assistants, dental hygiene, and mental and behavioral health.

Each school will determine the eligibility of students based on financial need and whether a student is from a disadvantaged background.

The SDS application is for electronic preparation and submission through the Electronic Hand Book (EHB). The SDS Program Guidance is available through the EHBs with Program Specific Form Instructions. Applicants use the SF 424 R & R as the Application Face Page. In order to submit the application electronically, all applicants must register in grants.gov.

There are no changes to the form itself other than the order of the questions. The “Public or Non-Profit Institution” moved from K. to A. and the “Point of Contact” moved from H. to B.

Program Specific Form:

1. Public or Non-Profit Institution

2. Point of Contact

3. Full-time Students enrolled in the Program for the Academic Year 20XX-20XX and Their Racial/Ethnic Backgrounds. The schools are to identify their students under the following categories:

Ethnicity:

Hispanic or Latino: A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

Non-Hispanic or Latino: A person not having origins of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

Race:

American Indian or Alaska Native: A person having origins in any of the original peoples of

North America, and who maintains cultural identification through tribal affiliation or community recognition.

_{Black or African American: A person having origins in any of the Black racial groups of Africa.}

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Native Hawaiian or Pacific Islander: A person having origins in any of the original peoples

of Hawaii, Guam, Samoa, or other Pacific Islands.

White: A person having origins in any of the original peoples of Europe, North America, the _{Middle East or North Africa.}

_{More than One Race: A person having origins from more than one race.}

_{Race Not Reported:} Race unknown

4. Total Full-time Enrollment and Full-Time Students from a Disadvantaged Background Enrollment by Class Year for Students in the Program for Academic Year 20XX-20XX.

5. Total Number of Full-time Students Graduated and Number of Full-time Students from a Disadvantaged Background graduated from your Program for Academic Year 20XX-20XX.

6. Graduates from your program serving in Primary Care and/or Medically Underserved Communities

7. Cost of Full-Time Tuition for this Program

8. Length of Program

9. Accreditation

10. Requested Award Amount

11. Students Supported

12. Certification and Eligibility Questions

13. Community College Question

14. Recruitment and Retention Eligibility

15. Recruitment Activities

16. Retention and/or Mentoring Activities

3. Use of Improved Information Technology

The entire application is completed in the Grants.gov system.

4. Efforts to Identify Duplication and Use of Similar Information

Information requested in the application is specific to the applicant and are unique to this program.

5. Impact on Small Business or Other Small Entities

This data collection will not have a significant impact on a substantial number of small entities. Only the minimum information necessary to make awards is requested.

6. Consequences if Information Collected Less Frequently

The information requested in the application is collected every four years since the SDS program is a competitive four-year project grant. In the absence of collection of these data, the review, selection, and approval of qualified applicants could not be carried out.

6. Special Circumstances Relating to the Guidelines in 5 CFR 1320.5(d)(2)

The information collected is consistent with the Guidelines in 5 CFR 1320.5(d)(2)

6. (a) A 60-day Federal Register Notice was published on July 19, 2016, volume 81, page 46941. There were no public comments.

8. (b) Comments in Response to the Federal Register Notice/Outside Consultation

The following SDS schools were contacted by program staff regarding the format, content of data to be collected, and time to complete the application and report. Based upon program experience in the past and recent comments from the schools, an average of 13 hours is required to complete the application.

Dr. Leslie Roundtree

Project Director

Chicago State University

Chicago, IL 60628

773- 995-2525

Mr. Randy Strickland

Project Director

Spalding University

Louisville, KY 40203

502-873-4405

Robin Johnson Piper

Project Director

Texas Woman’s University

Denton, TX 76204

940-898-3861

Theodore Collier

Project Director

Dillard University

New Orleans, LA 70122

504-816-4018

Brian Bride

Project Director

University of Georgia

Athens, GA 30602

706-542-5425

Rozanna Aitcheson

Project Director

Howard University

Washington, DC 20059

202-806-4338

Michelle Wortel

Project Director

University of Illinois

Chicago, IL 60628

312-996-3209

Frank Ambriz

Chair and Clinical Associate Professor

UT System Professional Scholar

University of Texas Pan Am

Physician Assistant Department

956-665-7049

Roberta (Bobby) Becka
Director of Grants Development
El Camino Community College District

Business Training Center
13430 Hawthorne Blvd., Hawthorne, CA 90250

Tel: (310) 973-3134

8. Explanation of any Payment/Gift to Respondents

There will be no payment/gift to respondents.

8. Assurance of Confidentiality Provided to Respondents

The HRSA Privacy Act Coordinator determined that a system of records notice is not required because the student records associated with these programs are maintained by participating institutions. Identifiable information is not submitted through the Grants.gov system. Data will be kept private to the extent allowed by law.

8. Justification for Sensitive Questions

We collect enrollment information on race/ethnicity to calculate the “Under-represented minority students” priority type. To be eligible for this priority, applicants must have a certain percentage of racial and ethnic minorities in their student population.

8. Estimate of Annualized Hour and Cost of Burden

The following is an estimate of the total reporting burden:

Form	Number of Respondents	Responses per Respondents	Total Annual Response	Hours per Response	Total Burden Hours	Dollar Wage Rate	Total Hour Cost
SDS App	400	1	400	13	5,200	$34.85	$181,220
Total	400		400		5,200		$181,200

Basis for Estimates for the Application

Application: In FY 2012, the SDS program was changed from a one-year project period to a four-year project period. The next anticipated SDS competition cycle will be in FY 2020. The number of SDS applicants is estimated to be approximately 400. Each applicant must complete one application. The application consists of general information, instructions, and a data form. Some information should be readily available and some tracking of graduates will be necessary in order to comply with the mandated statutory requirements. Based on conversations with schools that are familiar with the program, they estimate that will take approximately 13 hours to review the instructions, collect data, and complete the form (400 applicants X 13 hours/response = 5,200 hours of response burden).

We estimate that the costs to the public will be $ 181,220 (13 hours X $34.85/hour = $ 453.05 x 400 applicants = $ 181,220). An average wage rate for an employee to process the form for the SDS program application is $ 34.85 per hour.

We estimate that the total cost to the public for the Application will be $181,220.

8. Estimates of other Total Annual Cost Burden to Respondents or Record keeper/Capital Costs

Schools will have no capital and start-up costs and no operational and maintenance costs.

8. Annualized Cost to Federal Government

The staff cost for application format, updates to program guidance, application acceptance, reviews and analysis of an estimated 400 applicants per year is expected to be $17,400 for the year.

Application & program guidance development,

Data input, review, analysis and approval $ 17,400

One GS-13 develops the application format, updates the program guidance, reviews, analyzes and approves the applications.

The SDS application information is transferred into the Electronic Hand Book (EHB). Application development and maintaining database is provided by the contractors, REI systems, Inc., estimated to be $9,000 per year.

An annual amount of $26,400 is estimated to be cost to the Federal Government (includes staff and REI contract) for the SDS Application.

15. Explanation for Program Changes or Adjustments

In FY 2012, the SDS program changed from a one- year formula grant to a four- year project competitive grant which lowers the number of eligible grantees. In the last clearance package we estimated 500 applications to be submitted. The old SDS formula program allowed all eligible applicants to receive funds. The numbers decreased from 500 applications to 400 applications since there were 400 applicants in FY 2012, but only 99 applicants were funded.

15. Plans for Tabulation, Publication, and Project Time Schedule

Tabulation and analysis is currently performed on the information collected to improve program management, evaluate the program outcomes, and report as needed to the Congress and the Department. We are requesting a 3-year clearance for the SDS application.

Application: The project period is four (4) years. The first year of the project period was July 1, 2016 –June 30, 2017. The second year of the project period will be July 1, 2017 – June 30, 2018. All subsequent years will run from July 1 of one year to June 30 of the next year. Funding beyond the first year is dependent on the availability of appropriated funds for the SDS program in subsequent fiscal years, grantee satisfactory performance, and a decision that continued funding is in the best interest of the Federal Government. The next application cycle is anticipated to be FY 2020. In FY 2020 we will need to publish a Funding Opportunity Announcement (FOA) for the program.

Data are provided on numbers of full-time student enrollment and their racial/ethnicity data, disadvantaged full-time enrollment by class year, full-time students graduated, full-time students from disadvantaged backgrounds graduated, and full-time graduates serving in Medically Underserved Communities. Numbers of full-time graduates serving primary care must be provided only for schools of medicine, osteopathic medicine, dentistry, nursing (graduate degree program), physician assistants, dental hygiene, and mental and behavioral health.

15. Reason(s) Display Expiration Date is Inappropriate

The expiration date will be displayed.

15. Exceptions to Certification for Paperwork Reduction Act Submission

This fully complies with the guidelines set forth in 5 CFR 1320.9. The certifications are included in the package.