The National Health Service Corps (NHSC) Loan Repayment Program Application

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⚠️ Notice: This information collection may be referencing outdated material.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 1 The National Health Service Corps (NHSC) Loan Repayment Program Application Form and Instruction
FY 2019 NHSC LRP-Review-User-Guide.pdf Instruction
1 FY 2020 Combined Application Content DRAFT.pdf FY 2020 Combined Application Content DRAFT.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	The National Health Service Corps (NHSC) Loan Repayment Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 621

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	FY 2020 Combined Application Content DRAFT.pdf	FY 2020 Combined Application Content DRAFT.pdf		Yes	Yes	Fillable Fileable
Instruction			FY 2019 NHSC LRP-Review-User-Guide.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: The Public Health Service and National Health Service Corps Health Care Provider Records System	FR Citation: 58 FR 12968

Number of Respondents: 9,020	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	9,020	820	8,200
Annual IC Time Burden (Hours)	9,020	820	8,200
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.