Information Collection

NHSC SP – Acceptance/Verification of Good Standing Report

IC 211157 under ICR 202305-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1D NHSC SP – Acceptance/Verification of Good Standing Report Form and Instruction
1D NHSC SP-Acceptance Verification of Good Standing Report Acceptance Verification of Good Standing Report.pdf Form and Instruction
1D NHSC SP-Acceptance Verification of Good Standing Report Acceptance Verification of Good Standing Report.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NHSC SP â Acceptance/Verification of Good Standing Report	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1D	NHSC SP-Acceptance Verification of Good Standing Report	Acceptance Verification of Good Standing Report.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,575	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,575	686	1,889
Annual IC Time Burden (Hours)	644	172	472
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.