APPLICATION FOR PARTICIPATION IN THE NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM

ICR 198412-0915-002

OMB: 0915-0072

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0915-0072 198412-0915-002
Historical Active 198308-0915-009
HHS/HSA
APPLICATION FOR PARTICIPATION IN THE NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM
Revision of a currently approved collection   No
Regular
Approved without change 01/29/1985
Retrieve Notice of Action (NOA) 12/19/1984
  Inventory as of this Action Requested Previously Approved
09/30/1986 09/30/1986 12/31/1984
600 0 950
600 0 950
0 0 0

THIS FORM WILL BE USED TO IDENTIFY APPLICANTS FOR PARTICIPATION IN THE NATIONAL HEALTH SERVICE CORPS (NHSC) SCHOLARSHIP PROGRAM. THE INFORMATION COLLECTED WILL ENABLE THE PROGRAM TO DETERMINE ELIGIBILITY AND SELECT APPLICANTS FOR AN AWARD.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR PARTICIPATION IN THE NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM HRA-98

  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 600 950 0 0 -350 0
Annual Time Burden (Hours) 600 950 0 0 -350 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.
12/19/1984


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