NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM APPLICATION

ICR 199101-0915-002

OMB: 0915-0146

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0915-0146 199101-0915-002
Historical Active
HHS/HSA
NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM APPLICATION
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/11/1991
Retrieve Notice of Action (NOA) 01/28/1991
This information collection is approved for use until April 30, 1992. Based on changes to the NHSC authorizing legislation, the regulations governing this program may be subject to change. Upon its next submission, HHS/HRSA should submit the scholarship application and the applicant information bulletins and highlight any revisions made necessary by changes in the legislation. Approval of the 'other' race category in Question 8 is conditional on the agency's ability to demonstrate that the data collected through this category can be aggregated to the other basic race categories as outlined in Directive No. 15. Also, prior to use of the form, Question 8a reflects a printing error. Question 8a should be correctly numbered as Question 8.
  Inventory as of this Action Requested Previously Approved
04/30/1992 04/30/1992
3,000 0 0
3,000 0 0
0 0 0

HEALTH PROFESSIONS STUDENTS APPLYING FOR NATIONAL HEALTH SERVICE CORPS SCHOLARSHIPS PROVIDE INFORMATION NEEDED TO DETERMINE ELIGIBILITY FOR T PROGRAM.

None
None


No

1
IC Title Form No. Form Name
NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM APPLICATION

  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 3,000 0 0 3,000 0 0
Annual Time Burden (Hours) 3,000 0 0 3,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
01/28/1991


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