Information Collection

Application For Participation In The Indian Health Service Scholarship Program

IC 110233 under ICR 198802-0915-001 · OMB 0915-0072.

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Information Collection (IC) Details

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IC Title:	APPLICATION FOR PARTICIPATION IN THE INDIAN HEALTH SERVICE SCHOLARSHIP PROGRAM	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HRSA-856	No	No
Form	HRSA-856-1	No	No
Form	(III)	No	No
Form	856-1 (IV)	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	2,625	2,625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.