Employment Verification Form

NURSE Corps Loan Repayment Program

OMB: 0915-0140

IC ID: 182803

Information Collection (IC) Details

View Information Collection (IC)

Employment Verification Form
 
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 7 LRP Nurse Faculty Employment Verification Form NC LRP Nurse Faculty Employment Verification Form.docx Yes Yes Fillable Fileable

Health Health Care Services

Public Health Service and National Health Service Corps Scholarship/Loan Repayment Participants Records System  58 FR 12968

7,100 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 7,100 0 0 0 0 7,100
Annual IC Time Burden (Hours) 710 0 0 0 0 710
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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