Information Collection

The National Health Service Corps (NHSC) Loan Repayment Program

IC 6365 under ICR 200708-0915-002 · OMB 0915-0127.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0127 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form nhsc lrp The National Health Service Corps (NHSC) Loan Repayment Program	Form
nhsc lrp nhsc lrp 0127 forms.pdf	Form

IC Title:

The National Health Service Corps (NHSC) Loan Repayment 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: 42 CFR 621

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 lrp	nhsc lrp	0127 forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: The Public Health Service and National Health Service Corps Health Care Provider Records System

FR Citation: 58 FR 12968

Number of Respondents: 1,920

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,920	420	1,500
Annual IC Time Burden (Hours)	960	-1,203	2,163
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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