NHSC Travel Request Worksheet

National Health Service Corps Scholar/Students to Service Travel Request Worksheet

OMB: 0915-0278

IC ID: 6531

Information Collection (IC) Details

View Information Collection (IC)

NHSC Travel Request Worksheet
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 NHSC Travel Form NHSC Travel Form 0278 Form 11-2015_Clean.doc Yes Yes Fillable Fileable

Health Health Care Services

PHS and NHSC Scholarship and Loan Repayment Records System  58 FR 12968

300 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 600 0 100 0 0 500
Annual IC Time Burden (Hours) 40 0 7 0 0 33
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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