Disadvantaged Background Form

NURSE Corps Loan Repayment Program

OMB: 0915-0140

IC ID: 239775

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Disadvantaged Background Form
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 4 NC LRP - DAB Form - Revised.docx NC LRP - DAB Form - Revised.docx Yes Yes Fillable Fileable

Health Health Care Services

 

450 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 450 0 450 0 0 0
Annual IC Time Burden (Hours) 90 0 90 0 0 0
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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