Nurse Corps Nurse Faculty Employment Verification Form

NURSE Corps Loan Repayment Program

OMB: 0915-0140

IC ID: 239781

Information Collection (IC) Details

View Information Collection (IC)

Nurse Corps Nurse Faculty 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 1 Employment Verification Form Mock-Up Employment Verification Form - Mock up.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

450 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 450 0 0 0 0 450
Annual IC Time Burden (Hours) 90 0 0 0 0 90
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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