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Nurse Corps Crtiical Shortage Facility (CSF) Verification Form

IC 239779 under ICR 202508-0915-001 · OMB 0915-0140.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Nurse Corps Crtiical Shortage Facility (CSF) Verification Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 NC LRP Employment Verification Form Nurse Corps Critical Shortage Facility Verification Form.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

989 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 989 0 489 0 0 500
Annual IC Time Burden (Hours) 99 0 49 0 0 50
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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