Form 6 Initial Employment Verification Form

The Nursing Scholarship Program

Initial Employment Verification Form

Initial Employment Verification Form

OMB: 0915-0301

Document [pdf]
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Public Burden Statement:
The purpose of the Nurse Corps Scholarship Program (Nurse Corps SP) is to provide
scholarships to nursing students in exchange for a minimum two-year full-time service
commitment (or part-time equivalent), at an eligible health care facility with a critical shortage
of nurses.  The information that applicants supply is used to evaluate their eligibility,
qualifications and to assess their continued compliance with the applicable standards for
participation in the Nurse Corps SP.  The OMB control number for this information collection
is 0915-0301 and it is valid until 05/31/2021. This information collection is voluntary. Public
reporting burden for this collection of information is estimated to average .8 hours per
response, including the time for reviewing instructions, searching existing data sources, and
completing and reviewing the collection of information. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B,
Rockville, Maryland, 20857 or [email protected]
File Typeapplication/pdf
AuthorVossen-fidalgo, Elisangela (HRSA)
File Modified2020-02-14
File Created2020-01-23

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