The NHSC and NURSE Corps Interest Capture Form

Forms and Documents

Document Name	Status
Form 1 NHSC and NURSE Corps Interest Capture Form Form	Modified
0915-0337 - Section 846 of the PHS Act - Attachment C.pdf Supplementary Document	2025-12-16
0915-0337 - Section 338A-H of the PHS Act - Attachment B.pdf Supplementary Document	2025-12-16
0915-0337 - Section 331 of the PHS Act - Attachment A.pdf Supplementary Document	2025-12-16
NHSC-NC Interest Capture Form SS-A - Revised 12.5.25.docx Supporting Statement A	2025-12-16

IC Document Collections

IC ID	Document Title	Status
195587	NHSC and NURSE Corps Interest Capture Form Form	Modified

ICR Details

OMB Control No: 0915-0337	ICR Reference No: 202512-0915-002
Status: Received in OIRA	Previous ICR Reference No: 202305-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No: 21466
Title: The NHSC and NURSE Corps Interest Capture Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/16/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	17,676	16,144
Time Burden (Hours)	442	404
Cost Burden (Dollars)	0	0

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Abstract: The NHSC and Nurse Corps Interest Capture Form, which can be accessed on the HRSA website at https://bhw.hrsa.gov/about-us/ask-question, is an optional form that a health profession student, licensed clinician, faculty member, clinical site administrator, or other interested individual can complete and submit to HRSA online. The purpose of the form is to allow individuals to voluntarily ask questions about the NHSC and/or Nurse Corps Scholarship and Loan Repayment Programs, and to provide their contact information so that HRSA may provide them with direct responses, periodic program updates, and other general information via e-mail. Completed forms will contain information such as the names and roles of the individual(s), their phone number(s) and email address(es), and the HRSA program(s) in which they are interested or about which they have questions.

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Authorizing Statute(s): US Code: 42 USC 254l-1, Section 338B Name of Law: PHSA
   US Code: 42 USC 254l Section 338A Name of Law: PHSA
   US Code: 42 USC 254d(i)), Section 331(i) Name of Law: PHSA, as amended
   US Code: 42 USC 254m-q, Sections 338C-H Name of Law: PHSA
   US Code: 42 USC 297(n)(d), Section 846(d) Name of Law: PHSA, as amended
  

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 35914	07/30/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 58252	12/16/2025
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
NHSC and NURSE Corps Interest Capture Form	1	NHSC NC Interest Capture 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	17,676	16,144	0	1,532	0	0
Annual Time Burden (Hours)	442	404	0	38	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: Estimated burden is expected to increase due to a higher number of respondents (an increase from 16,144 to 17,676). As a result, the estimated burden is expected to increase from 404 to 442 hours.

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Annual Cost to Federal Government: $10,383

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]? 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: 12/16/2025

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