NHSC Site Application (including recertification)

The National Health Service Corps (NHSC) Loan Repayment Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0127 can be found here:

Documents and Forms

Document Name Document Type
Form 7 NHSC Site Application (including recertification) Form and Instruction
7 FY20 New Site Application Content Package.docx FY20 New Site Application Content Package.docx Form and Instruction

Information Collection (IC) Details

IC Title:	NHSC Site Application (including recertification)	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7	FY20 New Site Application Content Package.docx	FY20 New Site Application Content Package.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,070	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,070	370	3,700
Annual IC Time Burden (Hours)	2,035	185	1,850
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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