REQUEST FOR DEFERMENT - REQUEST FOR CHANGE IN DEFERMENT

ICR 197803-0935-002

OMB: 0935-0008

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
112073 Migrated
ICR Details
0935-0008 197803-0935-002
Historical Active 197509-0935-001
HHS/AHRQ
REQUEST FOR DEFERMENT - REQUEST FOR CHANGE IN DEFERMENT
Revision of a currently approved collection   No
Regular
Approved without change 03/17/1978
Retrieve Notice of Action (NOA) 03/09/1978
  Inventory as of this Action Requested Previously Approved
06/30/1981 06/30/1981 06/30/1978
2,000 0 1,000
167 0 167
0 0 0

THE HEALTH PROFS. EDUC. ASSISTANCE ACT OF 1976, PL94-484, AUTHORIZED THE NHSC SCHOLARSHIP PROGRAM, DESIGNATED AS SEC. 751 THRU 756 OF THE PHS ACT. THE REQUEST FOR DEFERMENT FORM IS USED TO ENABLE SENIOR MEDICAL, OSTEOPATHIC, AND DENTAL STUDENTS TO APPLY FOR DEFERMENT REQUEST FOR ADDITIONAL PERIOD OF DEFERMENT IS USED TO ENABLE PARTICIPANTS TO EXTEND AN APPROVED PERIOD OF DEFERRMENT.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR DEFERMENT - REQUEST FOR CHANGE IN DEFERMENT HRA223, HRA224

  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 2,000 1,000 0 1,000 0 0
Annual Time Burden (Hours) 167 167 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/09/1978


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