Information Collection

NHSC Travel Request Worksheet

IC 6531 under ICR 200912-0915-002 · OMB 0915-0278.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.