Information Collection

Scholarship Program Agreement

IC 193116 under ICR 202310-0917-001 · OMB 0917-0006.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form IHS-817 Scholarship Program Agreement	Form
IHS-817 Scholarship Program Agreement IHS-817_2023-2024 Final.pdf	Form
IHS-817 Scholarship Program Agreement IHS-817_2023-2024 Final.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 2 CFR 3506

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	IHS-817	Scholarship Program Agreement	IHS-817_2023-2024 Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title: IHS Scholarship Program

FR Citation: 74 FR 50222

Number of Respondents: 60

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	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	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.