Information Collection

S2S LRP - Letters of Recommendation

IC 211165 under ICR 202006-0915-004 · OMB 0915-0146.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NHSC S2S LRP Preceptor Letter of Rec Inst. Form.pdf	Other-Preceptor L or R
NHSC S2S LRP Additional Letter of Rec Ins. Form.pdf	Other-Addtnl L of R

IC Title:

S2S LRP - Letters of Recommendation

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
Other-Preceptor L or R			NHSC S2S LRP Preceptor Letter of Rec Inst. Form.pdf		No		Paper Only
Other-Addtnl L of R			NHSC S2S LRP Additional Letter of Rec Ins. Form.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	400	200	200
Annual IC Time Burden (Hours)	400	300	100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.