Application for Participation in the National Health Service Corps Scholarship Program

ICR 199506-0915-004

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 199506-0915-004
Historical Active 199504-0915-001
HHS/HSA
Application for Participation in the National Health Service Corps Scholarship Program
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 06/16/1995
Retrieve Notice of Action (NOA) 06/14/1995
  Inventory as of this Action Requested Previously Approved
04/30/1997 04/30/1997
5,000 0 0
5,000 0 0
0 0 0

This is a request for a 1-year extension, no change, of the approval for the application form used by students to apply for scholarship support. During the next year, proposed changes to the application form will be pilot-tested. Changes to the form will be submitted for OMB approval late in 1995.

None
None


No

1
IC Title Form No. Form Name
Application for Participation in the National Health Service Corps Scholarship Program

  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 5,000 0 0 5,000 0 0
Annual Time Burden (Hours) 5,000 0 0 5,000 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.
06/14/1995


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