Information Collection

Receipt of Application

IC 183615 under ICR 200801-0917-002 · OMB 0917-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0006 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
815.pdf ihs form 815	IC Document

IC Title:

Receipt of Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 2 CFR 3506

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

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title: IHS Scholarship Program

FR Citation: 72 FR 5446

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ihs form 815	815.pdf	12/04/2007

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