Information Collection

Deferment Request Form for the National Health Service Corps and Native Hawaiian Health Scholarship Programs

IC 6405 under ICR 199711-0915-004 · OMB 0915-0179.

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Information Collection (IC) Details

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IC Title:	Deferment Request Form for the National Health Service Corps and Native Hawaiian Health Scholarship Programs	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	700	470	230
Annual IC Time Burden (Hours)	400	270	130
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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