NHSC-NC Interest Capture Form SS-A - Revised 12.5.25

Health Resources and Services Administration

The National Health Service Corps and NURSE Corps Interest Capture Form

OMB Control No. 0915-0337

Revision

Supporting Statement A

A. Justification

1. Circumstances Making the Collection of Information Necessary

This is an information collection request for the revision, with changes, of the National Health Service Corps (NHSC) and NURSE Corps Programs’ Interest Capture From (OMB No.: 0915-0337, Expiration Date: 7/31/2026). The Interest Capture Form is used by potential applicants of the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce’s (BHW) NHSC and NURSE Corps programs. The legislative authorities for the NHSC program are Sections 331 and 338A-H of the Public Health Service (PHS) Act (Attachments A and B). The legislative authority for the NURSE Corps Program is Section 846 of the PHS Act (Attachment C).

Under the NHSC and NURSE Corps programs, the Department of Health and Human Services (HHS) enters into contracts with selected primary care health professionals who agree to provide primary health services at approved facilities in designated health professional shortage areas (HPSAs) or serve as nurse faculty employed by an accredited school of nursing. In return for these services, HHS agrees to provide financial support through scholarships or loan repayment which goes towards the health professionals' qualifying educational loans and/or educational costs.

The NHSC and NURSE Corps programs are both committed to improving the health of the Nation’s underserved by uniting communities in need with caring health professionals and by supporting communities’ efforts to build better systems of care. To recruit new applicants to the Programs and to fulfill increasing recruitment goals, HRSA is actively marketing the NHSC and NURSE Corps programs to currently practicing clinicians as well as students in health professions training programs.

2. Purpose and Use of Information Collection

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.

3. Use of Improved Information Technology and Burden Reduction

This information collection is an electronic form that is fillable and can be submitted online.

4. Efforts to Identify Duplication and Use of Similar Information

The information requested in the Interest Capture Form is specific to the applicant and unique to the NHSC and NURSE Corps programs.

5. Impact on Small Businesses or Other Small Entities

The information collection will not have a significant impact on small entities.

6. Consequences of Collecting the Information Less Frequently

The information collected in the Interest Capture Form is used to enable individuals and clinical sites to ask HRSA for periodic program updates and other general information regarding opportunities with the NHSC and/or the NURSE Corps via e-mail. The follow-up process for NHSC and NURSE Corps applicants is necessary to keep a potential applicant pool informed of the benefits of the NHSC and NURSE Corps and their potential membership into these programs. If HRSA did not collect information from these individuals the programs would miss an opportunity to reach out, engage, and obtain future applicants. The electronic form allows HRSA to solicit feedback from prospective applicants, active participants, and other key stakeholders of the NHSC and Nurse Corps programs that might otherwise be difficult to obtain. Questions and comments submitted via the form allow HRSA to evaluate the success of program communication efforts, make real-time adjustments, and better understand the experience of program stakeholders.

There are no legal obstacles to reduce the burden.

7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

The request fully complies with the regulation.

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

Section 8A

A 60-day Federal Register Notice published in the Federal Register on July 30, 2025, vol. 90, No. 144. 35914-15. There were no public comments. A 30-day Federal Register Notice published in the Federal Register on December 16, 2025, vol. 90, No. 239. pp. 58252-53.

Section 8B

To get an estimate of the burden collection for the approximate time (in hours) that it will take an individual to complete the Interest Capture Form. They attested that it took an average of 90 seconds for a respondent to complete the form.

9. Explanation of any Payment/Gift to Respondents

Respondents will not receive any payment or gifts.

10. Assurance of Confidentiality Provided to Respondents

Data will be kept private to the extent allowed by law. The Programs Interest Capture Form does not collect any PII data.

11. Justification for Sensitive Questions

There are no questions of a sensitive nature.

12. Estimates of Annualized Hour and Cost Burden

The estimated burden for this collection is 442 hours. This burden increased from the previous information collection request of 404 hours because the expected number of respondents is expected to increase from 16,144 to 17,676. The increase is likely due to increased traffic to the HRSA website overall, and/or normal fluctuations in annual web page statistics. The expected respondents are also the same and include individuals interested in the NHSC or NURSE Corps programs such as health professions students, clinicians, faculty at accredited health professions schools, and clinical site administrators.

Section 12A - Estimated Annualized Burden Hours

Burden Estimate:

Type of Respondent	Form Name	No. of Respondents	No. Responses per Respondent	Total Responses	Average Burden per Response (in hours)	Total Burden Hours
Interested Applicant	NHSC and NURSE Corps Programs Interest Capture Form	17,676	1	17,676	0.025	442
Total		17,676	--	17,676	--	442

Burden estimates were derived from annual use statistics of the online form. Based on the schedule, the NHSC and NURSE Corps were estimated to gather information from 17,676 individuals. Using this as a guide for future years, the estimated annual burden is as shown above as a total of 442 hours. It is estimated that it will take an average of 90 seconds to complete the Interest Capture Form. (17,676 interested applicants x (1 response x 1.5/60 hours/response per form) = 442 total burden hours).

Section 12B

Estimated Annualized Burden Costs

Type of Respondent	Total Burden Hours	Hourly Wage Rate1	Total Respondent Costs
Interested Applicant (e.g., Health Professions Students, Clinicians, Faculty)	442	$138.18	$61,076.00
Total			$61,076.00

HRSA used five different wage rates to represent the respondents:

• Registered Nurses, (29-1141) ($39.46/hr)

• Nurse Practitioners, (29-1171) ($57.78/hr)

• Physicians, (29-1210) ($109.12/hr)

• Family Medicine Physicians, (29-1215) ($100.34/hr)

• Nursing Instructors and Teachers, Postsecondary (25-1072) (faculty) $38.77/hr)

The average is an hourly wage of $69.09, which doubled is $138.18. The hourly rates were obtained at the BLS Wage Data page at https://www.bls.gov/bls/blswage.htm.

13. Estimates of other Total Annual Cost Burden to Respondents or Recordkeepers/Capital Costs

Other than their time, there is no cost to respondents.

14. Annualized Cost to Federal Government

The average annual costs to the government for collecting the NHSC and NURSE Corps Programs Interest Capture Form is as follows:

Instrument	GS-Level/Base Pay Rate	Project Time per FTE	Number of FTEs	Total Annual Cost
NHSC and NURSE Corps Programs Interest Capture Form Data Entry	$ 69,222 (GS-5, Step 1)	0.15	1	$10,383.30
Total				$10,383.30

The data entry of collected forms is minimal. One full time equivalent (FTE) at the GS-5, step 1 level, who spends 15% of their time (312 hours per year) inputting the contact information, has an annual salary of $69,222 (Locality Pay Area Washington-Baltimore-Arlington, DC-MD-VA-WVA-PA). It is estimated that the annualized total cost to the government is 10,383.30.

15. Explanation for Program Changes or Adjustments

There are no program changes or adjustments and there are no changes to the burden.

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

There are no plans for tabulation, statistical analysis, or publication of data requested.

17. Reason(s) Display of OMB Expiration Date is Inappropriate

The OMB number and expiration date will be displayed on every page of every form/instrument.

18. Exceptions to Certification for Paperwork Reduction Act Submissions

There are no exceptions to the certification.

1 Hourly Wage Rate based on the United States Department of Labor, Bureau of Labor Statistics released for May 2024. Hourly median wage doubled to account for benefits

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