APPLICATION FOR PARTICIPATION IN THE NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM THE INDIAN HEALTH SERVICE SCHOLARSHIP PROGRAM

ICR 198610-0915-002

OMB: 0915-0072

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0915-0072 198610-0915-002
Historical Active 198412-0915-002
HHS/HSA
APPLICATION FOR PARTICIPATION IN THE NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM THE INDIAN HEALTH SERVICE SCHOLARSHIP PROGRAM
Revision of a currently approved collection   No
Regular
Approved without change 12/10/1986
Retrieve Notice of Action (NOA) 10/01/1986
  Inventory as of this Action Requested Previously Approved
09/30/1987 09/30/1987 12/31/1986
1,910 0 600
1,910 0 600
0 0 0

THIS FORM WILL BE USED TO IDENTIFY APPLICANTS FOR PARTICIPATION IN THE NATIONAL HEALTH SERVICE CORPS/INDIAN HEALTH SERVICE SHOLARSHIP PROGRAMS. THE INFORMATION COLLECTED WILL ASSIST THE PROGRAM IN DETERMINING A STUDENT'S ELIGIBILITY TO PARTICIPATE IN THE NHSC AND IHS SCHOLARSHIP PROGRAMS AN TO BE SELECTED FOR APPROVAL FOR AN INITIAL SCHOLARSHIP AWARD.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR PARTICIPATION IN THE NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM THE INDIAN HEALTH SERVICE SCHOLARSHIP PROGRAM HRSA-856

  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 1,910 600 0 0 1,310 0
Annual Time Burden (Hours) 1,910 600 0 0 1,310 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.
10/01/1986


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