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Application for Participation in the National Health Service Corps Scholarship Program
Application for Participation in the National Health Service Corps Scholarship Program
OMB: 0915-0146
IC ID: 6375
OMB.report
HHS/HSA
OMB 0915-0146
ICR 200702-0915-003
IC 6375
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0146 can be found here:
2023-05-09 - Revision of a currently approved collection
2020-06-17 - Revision of a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
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
Federal Enterprise Architecture Business Reference Module
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 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,800
0
-1,300
0
0
3,100
Annual IC Time Burden (Hours)
1,950
0
-1,150
0
0
3,100
Annual IC Cost Burden (Dollars)
0
0
-8,000
0
0
8,000
Documents for IC
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.