Information Collection

Application for Participation in the National Health Service Corps Scholarship Program

IC 6375 under ICR 200702-0915-003 · OMB 0915-0146.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0146 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form nhsc 0146 Application for Participation in the National Health Service Corps Scholarship Program	Form
nhsc 0146 nhsc scholarship application 0146 scholarship form.pdf	Form
0146 bulletin 07.doc Bulletin	IC Document

IC Title:

Application for Participation in the National Health Service Corps Scholarship Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	nhsc 0146	nhsc scholarship application	0146 scholarship form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Public Health Service National Health Service Corps Scholarship/Loan Repayment Participants Records System

FR Citation: 58 FR 12968

Number of Respondents: 1,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,800	-1,300	3,100
Annual IC Time Burden (Hours)	1,950	-1,150	3,100
Annual IC Cost Burden (Dollars)	0	-8,000	8,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Bulletin	0146 bulletin 07.doc

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