0127 NHSC Checklist

The National Health Service Corps (NHSC) Loan Repayment Program

OMB: 0915-0127

IC ID: 181469

Documents and Forms
Information Collection (IC) Details

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0127 NHSC Checklist
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 621

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form lrp checklist lrp checklist 0127 checklist.doc Yes Yes Fillable Fileable

Health Health Care Services

The Public Health Service and National Health Service Corps Health Care Provider Records System  58 FR 12968

4,433 0
   
Individuals or Households
 
   100 %

  Approved 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 4,433 2,513 0 0 0 1,920
Annual IC Time Burden (Hours) 887 503 0 0 0 384
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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