Information Collection

The Nursing Scholarship Program

IC 43610 under ICR 201812-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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: Unchanged

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
	Requested	Previously Approved
Annual Number of Responses for this IC	8,250	8,250
Annual IC Time Burden (Hours)	6,934	6,934
Annual IC Cost Burden (Dollars)	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.