Information Collection Request

Application for Participation in the IHS Scholarship Program

ICR 202003-0917-001 · OMB 0917-0006 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form IHS-856-6 Course Curriculum Verification Form Removed Available
Form IHS-856-3 Faculty/Employer Evaluation Form Removed Repair queued
Form IHS 818 Health Professions Contract Form Unchanged Repair queued
Form IHS-817 Scholarship Program Agreement Form Modified Repair queued
Form IHS-856-24 Faculty/Advisor Evaluation Form Removed Repair queued
Form IHS-856-23 Request for Credit Validation Form Unchanged Available
Form IHS-856-22 Change of Name or Address Form Unchanged Repair queued
Form IHS-856-21 Summer School Request Form Unchanged Available
Form IHS-856-19 Lost Stipend Payment Form Modified Repair queued
Form IHS-856-18 Request for Extern Travel Reimbursement Form Removed Available
Form IHS-856-17 Extern Site Preference Request Form Removed Repair queued
Form IHS-856-16 Annual Status Report Form Unchanged Repair queued
Form IHS-856-15 Placement Update Form Unchanged Repair queued
Form IHS-856-14 Notification of Deferment Program Form Modified Available
Form IHS-856-13 Notice of Impending Graduation Form Unchanged Repair queued
Form IHS-856-12 Preferred Placement Form Unchanged Repair queued
Form HS-856-11 Request for Approval of Deferment Form Modified Repair queued
Form IHS-856-10 Change of Status Form Unchanged Available
Form IHS-856-9 Notification of Academic Problem Form Modified Repair queued
Form ihs-856-8 Recipient's Initial Program Progress Report Form Modified Repair queued
Form IHS-856-7 Verification of Acceptance or Decline of Award Form Modified Repair queued
Form IHS-856-5 Delinquent Federal Debt Form Removed Repair queued
Supporting Statement for IHS Scholarship Program Application FINAL.docx Supporting Statement A Uploaded 2020-09-30 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
240987 IHS Scholarship Program Application Other-Web Site Apps New
193119 Course Curriculum Verification Form Removed
193118 Faculty/Employer Evaluation Form Removed
193117 Health Professions Contract Form Unchanged
193116 Scholarship Program Agreement Form Modified
183630 Faculty/Advisor Evaluation Form Removed
183629 Request for Credit Validation Form Unchanged
183628 Change of Name or Address Form Unchanged
183627 Summer School Request Form Unchanged
183625 Lost Stipend Payment Form Modified
183624 Request for Extern Travel Reimbursement Form Removed
183623 Extern Site Preference Request Form Removed
183622 Annual Status Report Form Unchanged
183621 Placement Update Form Unchanged
183620 Notification of Deferment Program Form Modified
183619 Notice of Impending Graduation Form Unchanged
183618 Preferred Placement Form Unchanged
183617 Request for Approval of Deferment Form Modified
183616 Change of Status Form Unchanged
183615 Notification of Academic Problem Form Modified
183614 Recipient's Initial Program Progress Report Form Modified
183613 Verification of Acceptance or Decline of Award Form Modified
183612 Delinquent Federal Debt Form Removed
ICR Details
0917-0006 202003-0917-001
Active 201609-0917-001
HHS/IHS 19731
Application for Participation in the IHS Scholarship Program
Revision of a currently approved collection   No
Regular
Approved with change 10/01/2020
Retrieve Notice of Action (NOA) 03/30/2020
  Inventory as of this Action Requested Previously Approved
10/31/2023 36 Months From Approved 09/30/2020
3,275 0 12,580
1,286 0 4,340
0 0 0

The IHS Scholarship Program offers qualified American Indian and Alaska Native health profession students a unique opportunity to establish an educational foundation as they prepare to pursue a career in Indian health. Each scholarship (Preparatory, Pre-Graduate and health professions) is defined by applicant and degree program eligibility and provides generous financial aid packages (information available at www.ihs.gov/scholarship). The ultimate goal of the program is to develop health care providers and the next leaders of Indian health communities. Since IHS began providing scholarship support to American Indian and Alaska Native students to pursue health profession careers in 1978, the program has grown to support, educate and place health care professionals within medically underserved Indian health programs throughout the continental United States and Alaska. Today, nearly 7,000 American Indian and Alaska Native students have received scholarship awards and many have committed to serving their health profession careers at IHS; some have even returned to serve their own Tribal communities.

PL: Pub.L. 94 - 437 522 Name of Law: Indian Health Care Improvement
  
None

Not associated with rulemaking

  84 FR 68938 12/17/2019
85 FR 16636 03/24/2020
No

17
IC Title Form No. Form Name
Notification of Academic Problem IHS-856-9 Notification of Academic Problem
Annual Status Report IHS-856-16 Annual Status Report
Summer School Request IHS-856-21 Summer School Request
Lost Stipend Payment IHS-856-19 Lost Stipend Payment
Change of Name or Address IHS-856-22 Change of Name or Address
Request for Credit Validation IHS-856-23 Request for Credit Validation
Delinquent Federal Debt IHS-856-5 Delinquent Federal Debt
Extern Site Preference Request IHS-856-17 Extern Site Preference Request
Request for Extern Travel Reimbursement IHS-856-18 Request for Extern Travel Reimbursement
Faculty/Advisor Evaluation IHS-856-24 Faculty-Advisor Evaluation
Faculty/Employer Evaluation IHS-856-3 Faculty/Employer Evaluation
Placement Update IHS-856-15 Placement Update
Notification of Deferment Program IHS-856-14 Notification of Deferment Program
Notice of Impending Graduation IHS-856-13 Notice of Impending Graduation
Preferred Placement IHS-856-12 Preferred Placement
Request for Approval of Deferment HS-856-11 Request for Approval of Deferment
Change of Status IHS-856-10 Change of Status
Recipient's Initial Program Progress Report ihs-856-8 Recipient's Initial Program Progress Report
Health Professions Contract IHS 818 Contract
Scholarship Program Agreement IHS-817 Scholarship Program Agreement
Verification of Acceptance or Decline of Award IHS-856-7 Verification of Acceptance or Decline of Award
Course Curriculum Verification IHS-856-6 Course Curriculum Verification
IHS Scholarship Program Application

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,275 12,580 0 145 -9,450 0
Annual Time Burden (Hours) 1,286 4,340 0 751 -3,805 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
The online application process decreased the number of scholars completing hard copy forms IHS-856-3, IHS-856-5, and IHS-856-6. While IHS has incorporated these forms in the online application process (i.e., forms IHS- 856-3, IHS-856-5 and IHS-856-6) the applicants still need to provide this information as part of the online, electronic application.

$145,223
No
    Yes
    Yes
No
No
No
No
Evonne Bennett-Barnes 301 443-4750 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/30/2020