Native Hawaiian Health Scholarship Program Application

The National Health Service Corps Scholarship Program, Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0146 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Native Hawaiian Health Scholarship Program Application Form and Instruction
NHHSP Online Application User Guide.pdf Instruction
1 NHHSP 2017-2018 Online Application and Forms.docx NHHSP 2017-2018 Online Application and Forms.docx Form and Instruction
2 NHHSP Letters of Recommendation Forms.docx NHHSP Letters of Recommendation Forms.docx Form
3 NHHSP Authorization to Release Information.docx NHHSP Authorization to Release Information.docx Form
4 NHHSP Verification of Good Standing.docx NHHSP Verification of Good Standing.docx Form

Information Collection (IC) Details

IC Title:	Native Hawaiian Health Scholarship Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	NHHSP 2017-2018 Online Application and Forms.docx	NHHSP 2017-2018 Online Application and Forms.docx	Yes	Yes	Fillable Fileable
Instruction			NHHSP Online Application User Guide.pdf	Yes	Yes	Fillable Fileable
Form	2	NHHSP Letters of Recommendation Forms.docx	NHHSP Letters of Recommendation Forms.docx	Yes	Yes	Fillable Fileable
Form	3	NHHSP Authorization to Release Information.docx	NHHSP Authorization to Release Information.docx	Yes	Yes	Fillable Fileable
Form	4	NHHSP Verification of Good Standing.docx	NHHSP Verification of Good Standing.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,360	1,360
Annual IC Time Burden (Hours)	528	528
Annual IC Cost Burden (Dollars)	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.