Information Collection

The Nursing Scholarship Program

IC 43610 under ICR 201504-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1 The Nursing Scholarship Program	Form and Instruction
1 Eligible Application Attachment B-Eligible Application screenshots .pdf	Form and Instruction
2 NCSP APG Attachment C-NCSP APG.docx	Form and Instruction
3 Graduation Close Out Form Attachment D-Graduation Close Out Form.docx	Form and Instruction
4 Confirmation of Interest Form Attachment E-Confirmation of Interest Form Screenshots.docx	Form and Instruction
5 Contract Attachment F-Contract.pdf	Form and Instruction
6 DCW Attachment G-DCW Screen shot.docx	Form and Instruction
7 School Enrollment Verification Form Attachment H-School Enrollment Verification Form.pdf	Form and Instruction
8 Initial Employment Verification Form Attachment I-Initial Employment Verification Form.pdf	Form and Instruction
9 Participant Service Verification Attachment J-Employer -Participant Service Verification Screenshots .pdf	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	1	Eligible Application	Attachment B-Eligible Application screenshots .pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	NCSP APG	Attachment C-NCSP APG.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Graduation Close Out Form	Attachment D-Graduation Close Out Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	Confirmation of Interest Form	Attachment E-Confirmation of Interest Form Screenshots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	5	Contract	Attachment F-Contract.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	6	DCW	Attachment G-DCW Screen shot.docx	Yes	Yes	Fillable Fileable
Form and Instruction	7	School Enrollment Verification Form	Attachment H-School Enrollment Verification Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	8	Initial Employment Verification Form	Attachment I-Initial Employment Verification Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	9	Participant Service Verification	Attachment J-Employer -Participant Service Verification Screenshots .pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,550

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	8,050	2,350	5,700
Annual IC Time Burden (Hours)	6,891	-3,309	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.