Information Collection

IHS Scholarship Program Application

IC 240987 under ICR 202003-0917-001 · OMB 0917-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0006 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SCHOLARSHIP PROGRAM WEB SITE APPLICATION.pdf www.ihs.gov/scholarship	Other-Web Site Apps
Supporting_Statement_for_OMB_No__0917-0006 FINAL 3.29.20.docx Supporting Statement	IC Document

IC Title:

IHS Scholarship Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Other-Web Site Apps			SCHOLARSHIP PROGRAM WEB SITE APPLICATION.pdf	www.ihs.gov/scholarship	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 850

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
Annual Number of Responses for this IC	850	850
Annual IC Time Burden (Hours)	850	850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting_Statement_for_OMB_No__0917-0006 FINAL 3.29.20.docx	03/29/2020

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