NHSC and Native Hawaiian Health Scholarship Programs Data Collection Worksheet

ICR 200108-0915-001

OMB: 0915-0226

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
0915-0226 200108-0915-001
Historical Active 199808-0915-004
HHS/HSA
NHSC and Native Hawaiian Health Scholarship Programs Data Collection Worksheet
Extension without change of a currently approved collection   No
Regular
Approved without change 10/09/2001
Retrieve Notice of Action (NOA) 08/20/2001
  Inventory as of this Action Requested Previously Approved
10/31/2004 10/31/2004 10/31/2001
1 0 1
300 0 300
0 0 0

Scholarships are awarded to students pursuing health professions careers who enter into a contractual agreement under which the Agency pays the tuition, fees, educationa cost, needed to make awards and calculate the Federal income tax withholdings.

None
None


No

1
IC Title Form No. Form Name
NHSC and Native Hawaiian Health Scholarship Programs Data Collection Worksheet

  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 1 0 0 0 0
Annual Time Burden (Hours) 300 300 0 0 0 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.
08/20/2001


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