Information Collection

NHSC and NURSE Corps Interest Capture Form

IC 195587 under ICR 202004-0915-006 · OMB 0915-0337.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0337 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NHSC and NURSE Corps Interest Capture Form Form
1 NHSC-NC Interest Capture Form.docx NHSC-NC Interest Capture Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NHSC and NURSE Corps Interest Capture Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	NHSC-NC Interest Capture Form.docx	NHSC-NC Interest Capture Form.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	60	60
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.