Information Collection

NHSC Travel Request Worksheet

IC 6531 under ICR 202404-0906-003 · OMB 0906-0087.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0087 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NHSC Travel Request Worksheet	Form
1 NHSC Travel Request Worksheet Form NHSC Travel Request Worksheet Form.docx	Form

IC Title:

NHSC Travel Request Worksheet

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:

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 Travel Request Worksheet Form	NHSC Travel Request Worksheet Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: PHS and NHSC Scholarship and Loan Repayment Records System

FR Citation: 86 FR 28362

Number of Respondents: 800

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,600	1,000	600
Annual IC Time Burden (Hours)	107	67	40
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.