Information Collection

NHSC SP Awardees Schools – Enrollment Verification Form

IC 211163 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⚠️ Notice: This information collection may be referencing outdated material.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 2E NHSC SP Awardees Schools – Enrollment Verification Form Form and Instruction
2E Enrollment Verification Form Enrollment Verification Form.pdf Form and Instruction
2E Enrollment Verification Form Enrollment Verification Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NHSC SP Awardees Schools â Enrollment Verification Form	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	2E	Enrollment Verification Form	Enrollment Verification Form.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	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.