NHSC Travel Request Worksheet

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0278 can be found here:

Documents and Forms

Document Name Document Type
Form 001_BCRS Travek Re NHSC Travel Request Worksheet Form
001_BCRS Travek Re 001_BCRS Travek Request NHSC Travel Form_0915-0278.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NHSC Travel Request Worksheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	001_BCRS Travek Request	001_BCRS Travek Request	NHSC Travel Form_0915-0278.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: PHS and NHSC Scholarship and Loan Repayment Records System	FR Citation: 58 FR 12968

Number of Respondents: 140	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	280	-220	500
Annual IC Time Burden (Hours)	17	-13	30
Annual IC Cost Burden (Dollars)	0	0	0

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.