Information Collection

The Nursing Scholarship Program

IC 43610 under ICR 201804-0915-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 B The Nursing Scholarship Program	Form and Instruction
B Attachment B-Eligible Application screenshots .pdf Attachment B-Eligible Application screenshots .pdf	Form and Instruction
C Attachment C-NCSP APG.docx Attachment C-NCSP APG.docx	Form and Instruction
D Attachment D-Graduation Close Out Form.docx Attachment D-Graduation Close Out Form.docx	Form and Instruction
E Attachment E - Confirmation of Interest Form Screenshots Attachement E - Confirmation of Interest Form Screenshots.pdf	Form and Instruction
F Attachment F-Contract.pdf Attachment F-Contract.pdf	Form and Instruction
G Attachment G - Data Collection Worksheet Screenshot.pdf Attachment G - Data Collection Worksheet Screenshot.pdf	Form and Instruction
H Attachment H - School Enrollment Verification Form.pdf Attachment H - School Enrollment Verification Form.pdf	Form and Instruction
I Attachment I-Initial Employment Verification Form.pdf Attachment I-Initial Employment Verification Form.pdf	Form and Instruction
J Attachment J - Employer-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	B	Attachment B-Eligible Application screenshots .pdf	Attachment B-Eligible Application screenshots .pdf	Yes	Yes	Fillable Fileable
Form and Instruction	C	Attachment C-NCSP APG.docx	Attachment C-NCSP APG.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D	Attachment D-Graduation Close Out Form.docx	Attachment D-Graduation Close Out Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	E	Attachment E - Confirmation of Interest Form Screenshots.pdf	Attachement E - Confirmation of Interest Form Screenshots.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	F	Attachment F-Contract.pdf	Attachment F-Contract.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	G	Attachment G - Data Collection Worksheet Screenshot.pdf	Attachment G - Data Collection Worksheet Screenshot.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	H	Attachment H - School Enrollment Verification Form.pdf	Attachment H - School Enrollment Verification Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	I	Attachment I-Initial Employment Verification Form.pdf	Attachment I-Initial Employment Verification Form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	J	Attachment J - Employer-Participant Service Verification Screenshots.pdf	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: 5,750

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	8,250	200	8,050
Annual IC Time Burden (Hours)	6,934	43	6,891
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	04/17/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.