S2S LRP – Authorization to Release Information

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

OMB: 0915-0146

IC ID: 211166

Information Collection (IC) Details

View Information Collection (IC)

S2S LRP – Authorization to Release Information
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3-3 NHSC S2S LRP Authorization to Release Information Form.pdf NHSC S2S LRP Authorization to Release Information Form.pdf Yes No Fillable Printable

Health Health Care Services

 

200 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 200 0 100 0 0 100
Annual IC Time Burden (Hours) 20 0 10 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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