The Nursing Scholarship Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0301 can be found here:

Documents and Forms

Document Name Document Type
Form 1a The Nursing Scholarship Program Form and Instruction
1a application screenshots Attachment B - Application Screenshots.docx Form and Instruction
1b Application Program Guidance Attachment C - Application Program Guidance.pdf Form and Instruction
2a In-school Monitoring DCW form Attachment E - IN-School Monitoring - NSP DCW Form Screenshots.docx Form and Instruction
1c Application contract Attachment D - Application - NSP Contract 2012-2013.pdf Form
2b In-School Monitoring - School Verification form Attachment F - IN-School Monitoring - School Verification Form.pdf Form and Instruction
3a In-Service Monitoring Initial Verification of Employment Attachment G - IN-Service Monitoring - Initial Verification of Employment Form.doc Form and Instruction
3b In-Service BCRS Verification Form Attachment H - In-Service Verification Form; BCRS.docx Form and Instruction
Attachment A - Nursing Legislation.pdf Nursing Legislation IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	The Nursing 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:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1a	application screenshots	Attachment B - Application Screenshots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1b	Application Program Guidance	Attachment C - Application Program Guidance.pdf	Yes	Yes	Printable Only
Form and Instruction	2a	In-school Monitoring DCW form	Attachment E - IN-School Monitoring - NSP DCW Form Screenshots.docx	Yes	Yes	Fillable Fileable
Form	1c	Application contract	Attachment D - Application - NSP Contract 2012-2013.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2b	In-School Monitoring - School Verification form	Attachment F - IN-School Monitoring - School Verification Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3a	In-Service Monitoring Initial Verification of Employment	Attachment G - IN-Service Monitoring - Initial Verification of Employment Form.doc	Yes	Yes	Fillable Fileable
Form and Instruction	3b	In-Service BCRS Verification Form	Attachment H - In-Service Verification Form; BCRS.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,700	600	5,100
Annual IC Time Burden (Hours)	10,200	0	10,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Nursing Legislation	Attachment A - Nursing Legislation.pdf	06/21/2012

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