Information Collection

Extern Site Preference Request

IC 183623 under ICR 201308-0917-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form IHS-856-17 Extern Site Preference Request	Form
IHS-856-17 Extern Site Preference Request IHS-856-17 EXT SITE PREF REQ.pdf	Form

IC Title:

Extern Site Preference Request

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 2 CFR 3506

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	IHS-856-17	Extern Site Preference Request	IHS-856-17 EXT SITE PREF REQ.pdf		No	No	Paper Only

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title: IHS Scholarship Program

FR Citation: 74 FR 50222

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	300	175	125
Annual IC Time Burden (Hours)	40	23	17
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.