Application for Participation in the National Health Service Corps Scholarship Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 Application for Participation in the National Health Service Corps Scholarship Program Form
0146 Scholar Bulletin.doc Instruction
1 1 0146 nhsc form 2007.pdf Form

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: 42 CFR 62.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	1	0146 nhsc form 2007.pdf		Yes	Yes	Fillable Fileable
Instruction			0146 Scholar Bulletin.doc		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,800	-1,300	3,100
Annual IC Time Burden (Hours)	5,400	2,300	3,100
Annual IC Cost Burden (Dollars)	0	-8,000	8,000

Documents for IC

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.