Authorization to Release Information Form

NURSE Corps Loan Repayment Program

OMB: 0915-0140

IC ID: 196033

Information Collection (IC) Details

View Information Collection (IC)

Authorization to Release Information Form
 
No Removed
 
Mandatory
 
5 CFR 1320.8(d) 31 CFR 208,210  (To search for a specific CFR, visit the Code of Federal Regulations.)

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

Health Health Care Services

Public Health Service and National Health Service Corps Scholarship/Loan Repayment Participants Records System  58 FR 12868

5,500 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 0 0 -5,500 0 0 5,500
Annual IC Time Burden (Hours) 0 0 -550 0 0 550
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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