NHSC Information Follow-up Form

ICR 201402-0915-005

OMB: 0915-0337

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
195587 Modified
ICR Details
0915-0337 201402-0915-005
Historical Active 201012-0915-002
HHS/HSA 21466
NHSC Information Follow-up Form
Extension without change of a currently approved collection   No
Regular
Approved with change 04/07/2014
Retrieve Notice of Action (NOA) 02/26/2014
  Inventory as of this Action Requested Previously Approved
04/30/2017 36 Months From Approved 04/30/2014
2,400 0 2,400
60 0 60
0 0 0

The National Health Service Corps (NHSC) is committed to improving the health of the Nation's underserved by uniting communities in need with caring health professionals and by supporting communities' efforts to build better systems of care. The NHSC Information Follow-up Form is an optional form that a health profession student, licensed clinician, faculty member, or clinical site administrator can fill out. This follow-up process is necessary to keep a potential applicant pool that is kept informed of the benefits of the NHSC and their potential membership into the Corps.

None
None

Not associated with rulemaking

  78 FR 69694 11/20/2013
79 FR 8978 02/14/2014
No

1
IC Title Form No. Form Name
NHSC Information Follow-up Form 1 NHSC and NURSE Corps Interest Capture Form

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,400 2,400 0 0 0 0
Annual Time Burden (Hours) 60 60 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$5,162
No
No
No
No
No
Uncollected
Jodi Duckhorn 301 443-1984

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/26/2014


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