Information Collection

Faculty/Employer Evaluation

IC 183610 under ICR 201006-0917-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
856-4.pdf ihs form 856-4 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Faculty/Employer Evaluation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 2 CFR 3506

Information Collection 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 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-3,000	3,000
Annual IC Time Burden (Hours)	-2,500	2,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ihs form 856-4	856-4.pdf	12/04/2007

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