Information Collection

NHSC Recruitment and Retention Assistance Application

IC 6469 under ICR 200807-0915-001 · OMB 0915-0230.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0230 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0230 NHSC Recruitment and Retention Assistance Application	Form
0230 instructions 08.doc	Instruction
0230 site application 0230 Application 2008 omb.doc	Form

IC Title:

NHSC Recruitment and Retention Assistance Application

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	0230	site application	0230 Application 2008 omb.doc		Yes	Yes	Fillable Fileable
Instruction			0230 instructions 08.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,900

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,900	2,900
Annual IC Time Burden (Hours)	1,450	1,450
Annual IC Cost Burden (Dollars)	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.