Information Collection

IHS Scholarship Program Application

IC 240987 under ICR 202310-0917-001 · OMB 0917-0006.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SCHOLARSHIP PROGRAM WEB SITE APPLICATION.pdf www.ihs.gov/scholarship	Other-Web Site Apps
SCHOLARSHIP PROGRAM WEB SITE APPLICATION.pdf www.ihs.gov/scholarship	Other-Web Site Apps
Supporting_Statement_for_OMB_No__0917-0006 FINAL 3.29.20.docx Supporting Statement	IC Document
Supporting_Statement_for_OMB_No__0917-0006 FINAL 3.29.20.docx Supporting Statement	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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
Other-Web Site Apps			SCHOLARSHIP PROGRAM WEB SITE APPLICATION.pdf	www.ihs.gov/scholarship	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 850

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	850	850
Annual IC Time Burden (Hours)	850	850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting_Statement_for_OMB_No__0917-0006 FINAL 3.29.20.docx	03/29/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.