The National Health Service Corps (NHSC) Loan Repayment Program Application

The National Health Service Corps (NHSC) Loan Repayment Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0127 can be found here:

Documents and Forms

Document Name Document Type
Form 1 The National Health Service Corps (NHSC) Loan Repayment Program Application Form and Instruction
1 NHSC LRP Application NHSC LRP Online Application User Guide Dec 2012.doc Form and Instruction

Information Collection (IC) Details

IC Title:	The National Health Service Corps (NHSC) Loan Repayment Program Application	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 621

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	NHSC LRP Application	NHSC LRP Online Application User Guide Dec 2012.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: The Public Health Service and National Health Service Corps Health Care Provider Records System	FR Citation: 58 FR 12968

Number of Respondents: 8,200	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	8,200	3,025	5,175
Annual IC Time Burden (Hours)	8,200	6,647	1,553
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.