Information Collection

NHSC and NURSE Corps Interest Capture Form

IC 195587 under ICR 202305-0915-002 · OMB 0915-0337.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0337 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NHSC and NURSE Corps Interest Capture Form	Form
1 NHSC NC Interest Capture Form NHSC-NC Interest Capture Form.docx	Form
1 NHSC NC Interest Capture Form NHSC-NC Interest Capture Form.docx	Form

IC Title:

NHSC and NURSE Corps Interest Capture Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	NHSC NC Interest Capture Form	NHSC-NC Interest Capture Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,144

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	16,144	13,744	2,400
Annual IC Time Burden (Hours)	404	344	60
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.