The Nursing Scholarship Program

Forms and Documents

Document Name	Status
Form 1 Eligible Applications/Application Program Guidance Form	Modified
Form 9 Authorization to Release Information Form Form	Modified
Form 8 Verification of Acceptance Form Form	Modified
Form 7 In Service Verification Form Form	Modified
Form 6 NC SP Employment Verification Form Form	Modified
Form 5 Graduation Close Out Form Form	Modified
Form 4 Data Collection Worksheet Form Form	Modified
Form 3 Confirmation of Interest Form Form and Instruction	Modified
Form 2 School Enrollment Verification Form Form	Modified
0915-0301- Supporting Statement A 08262025.docx Supporting Statement A	2025-08-28

IC Document Collections

IC ID	Document Title	Status
43610	Eligible Applications/Application Program Guidance Form	Modified
240484	Authorization to Release Information Form Form	Modified
240481	Verification of Acceptance Form Form	Modified
240480	In Service Verification Form Form	Modified
240478	NC SP Employment Verification Form Form	Modified
240475	Graduation Close Out Form Form	Modified
240473	Data Collection Worksheet Form Form	Modified
240471	Confirmation of Interest Form Form and Instruction	Modified
240469	School Enrollment Verification Form Form	Modified

ICR Details

OMB Control No: 0915-0301	ICR Reference No: 202508-0915-002
Status: Received in OIRA	Previous ICR Reference No: 202303-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: The Nursing Scholarship Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/29/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	18,400	8,750
Time Burden (Hours)	11,168	7,099
Cost Burden (Dollars)	0	0

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Abstract: The Nurse Corps SP collects data to determine an applicant’s eligibility for the program, monitor a participant’s continued enrollment in a school of nursing, monitor the participant’s compliance with the Nurse Corps SP service obligation, and prepare annual reports to Congress. Generally, the following information will be collected (1) from the schools of nursing, on a quarterly basis - general applicant and nursing school data such as full name, location, tuition/fees, and enrollment status; (2) from the schools of nursing, on an annual basis - data concerning tuition/fees and overall student enrollment status; and (3) from the participants and their employing Critical Shortage Facility (CSF), on a biannual basis - data concerning the participant’s employment status, work schedule, and leave usage.

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Authorizing Statute(s): US Code: 42 USC 297n(a), section 846(d) Name of Law: Public Health Service Act
  

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:
	90 FR 24635	06/11/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 42019	08/28/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

IC Title	Form No.	Form Name
Authorization to Release Information Form	9	Authorization To Release Information
Confirmation of Interest Form	3	Confirmation of Interest Form
Data Collection Worksheet Form	4	Data Collection Worksheet Form
Eligible Applications/Application Program Guidance	1	Nurse Corps SP Online Application User Guide
Graduation Close Out Form	5	Graduation Close Out Form
In Service Verification Form	7	In Service Verification (Screenshots)
NC SP Employment Verification Form	6	NC SP Employment Verification (Screenshot)
School Enrollment Verification Form	2	School Enrollment Verification Form
Verification of Acceptance Form	8	Verification of Acceptance Form

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ICR Summary of Burden

	Total Request	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	18,400	8,750	0	9,650	0	0
Annual Time Burden (Hours)	11,168	7,099	0	4,069	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The total burden hour request has changed from 7,099 to 11,168 due to an increase in the anticipated number of applications.

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Annual Cost to Federal Government: $775,789

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.     Yes

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.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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? No

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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: 08/29/2025

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