Information Collection

The Nursing Scholarship Program

IC 43610 under ICR 201206-0915-004 · OMB 0915-0301.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.