Information Collection

Eligible Applications/Application Program Guidance

IC 43610 under ICR 202003-0915-001 · OMB 0915-0301.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0301 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Eligible Applications/Application Program Guidance	Form
1 Eligible Applications/Application Program Guidance 2020 NCSP Application - Screenshots.pdf	Form
Attachment A - Nursing Legislation.pdf Nursing Legislation	IC Document

IC Title:

Eligible Applications/Application Program Guidance

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Eligible Applications/Application Program Guidance	2020 NCSP Application - Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,600	-5,650	8,250
Annual IC Time Burden (Hours)	5,200	-1,734	6,934
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Nursing Legislation	Attachment A - Nursing Legislation.pdf	04/17/2018

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