Application for Participation in the National Health Service Corps Scholarship Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0146 can be found here:

Documents and Forms

Document Name Document Type
Form NHSC_SP_001 Application for Participation in the National Health Service Corps Scholarship Program Form
FY2011 NHSC SP Guidance 10.25.10.docx Instruction
NHSC_SP_001 NHSC_SP_001 Instructions and Forms 2011.docx Form
NHSC_SP_002 Acceptance & Declination Form NHSC Applicant acceptance or denial letter-revised.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Participation in the National Health Service Corps Scholarship Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 62.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NHSC_SP_001	NHSC_SP_001	Instructions and Forms 2011.docx	Yes	Yes	Fillable Fileable
Instruction			FY2011 NHSC SP Guidance 10.25.10.docx	Yes	Yes	Fillable Fileable
Form	NHSC_SP_002	Acceptance & Declination Form	NHSC Applicant acceptance or denial letter-revised.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Public Health Service National Health Service Corps Scholarship/Loan Repayment Participants Records System	FR Citation: 58 FR 12968

Number of Respondents: 1,800	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	1,800	0	1,800
Annual IC Time Burden (Hours)	6,155	755	5,400
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.