Native Hawaiian Health Scholarship Program Application

The National Health Service Corps Scholarship Program, Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0146 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Native Hawaiian Health Scholarship Program Application Form and Instruction
NHHSP Online Application User Guide.pdf Instruction
1 NHHSP 2017-2018 Online Application and Forms.docx NHHSP 2017-2018 Online Application and Forms.docx Form and Instruction
2 NHHSP Letters of Recommendation Forms.docx NHHSP Letters of Recommendation Forms.docx Form
3 NHHSP Authorization to Release Information.docx NHHSP Authorization to Release Information.docx Form
4 NHHSP Verification of Good Standing.docx NHHSP Verification of Good Standing.docx Form

Information Collection (IC) Details

IC Title:	Native Hawaiian Health Scholarship 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:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	NHHSP 2017-2018 Online Application and Forms.docx	NHHSP 2017-2018 Online Application and Forms.docx	Yes	Yes	Fillable Fileable
Instruction			NHHSP Online Application User Guide.pdf	Yes	Yes	Fillable Fileable
Form	2	NHHSP Letters of Recommendation Forms.docx	NHHSP Letters of Recommendation Forms.docx	Yes	Yes	Fillable Fileable
Form	3	NHHSP Authorization to Release Information.docx	NHHSP Authorization to Release Information.docx	Yes	Yes	Fillable Fileable
Form	4	NHHSP Verification of Good Standing.docx	NHHSP Verification of Good Standing.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	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	1,360	1,110	250
Annual IC Time Burden (Hours)	528	278	250
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.