Authorization for Disclosure of Loan Information Form

The National Health Service Corps (NHSC) Loan Repayment Programs

OMB: 0915-0127

IC ID: 209460

Information Collection (IC) Details

View Information Collection (IC)

Authorization for Disclosure of Loan Information 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 3 Authorization for Disclosure of Loan Information Authorization for Disclosure of Loan Information Form.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

7,150 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 7,150 0 0 0 0 7,150
Annual IC Time Burden (Hours) 715 0 0 0 0 715
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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