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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.