Scholarships for Disadvantaged Students Application Program Specific Form

Forms and Documents

Document Name	Status
Form 1 Scholarships for Disadvantaged Students (SDS)Application Program Specific Form Form and Instruction	Modified
SDS Supporting Statement Final_11.18.19.docx Supporting Statement A	2019-11-22

IC Document Collections

IC ID	Document Title	Status
6377	Scholarships for Disadvantaged Students (SDS)Application Program Specific Form Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0149	ICR Reference No: 201910-0915-004
Status: Active	Previous ICR Reference No: 201612-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No: 20517
Title: Scholarships for Disadvantaged Students Application Program Specific Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/26/2019
	Date Received in OIRA: 11/05/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2022	36 Months From Approved	03/31/2020
Responses	323	0	400
Time Burden (Hours)	10,013	0	5,200
Cost Burden (Dollars)	0	0	0

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Abstract: Institutions are currently required to provide one year of data to demonstrate this eligibility requirement. Beginning with the next grant funding cycle, schools must provide the average for the most recent three-year period to demonstrate their eligibility. A three-year average is a more accurate portrayal of school enrollment patterns than one year. This change will allow SDS to support the grantees who have demonstrated a commitment over time to serving students from disadvantaged backgrounds.

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Authorizing Statute(s): PL: Pub.L. 105 - 392 739 Name of Law: Educational Assistance in the Health Professions Regarding Individuals from Disadvantaged Background
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 153	08/08/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 214	11/05/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Scholarships for Disadvantaged Students (SDS)Application Program Specific Form	1	SDS Program Specific Data Application_11-18-19.pdf

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ICR Summary of Burden

	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	323	400	0	-77	0	0
Annual Time Burden (Hours)	10,013	5,200	0	4,813	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are less respondents; respondents are now required to provide data every 3 years vs. 1 year previously. This change increases the burden to the respondents to provide more data every 3 years instead of less data every 1 year.

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Annual Cost to Federal Government: $24,844

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/05/2019

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