S2S LRP – Authorization to Release Information

Application for Participation in the National Health Service Corps Scholarship Program

OMB: 0915-0146

IC ID: 211166

Information Collection (IC) Details

View Information Collection (IC)

S2S LRP – Authorization to Release Information
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 S2S LRP – Authorization to Release Information S2S 1 Authorization to Release.docx Yes Yes Fillable Printable

Health Health Care Services

 

100 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 0 0 0 100
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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