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Federal forms, ICRs, and supporting documents

Information Collection

In Service Verification Form

IC 240480 under ICR 202508-0915-002 · OMB 0915-0301.

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Form
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Information Collection (IC) Details

View Information Collection (IC)

In Service 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 7 In Service Verification (Screenshots) 7_In Service Verification (Screenshots).docx Yes Yes Fillable Fileable

Health Health Care Services

HHS/HRSA/BHW Scholarship and Loan Repayment Program Records  86 FR 28362

1,000 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 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 240 0 0 0 0 240
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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