Information Collection

NHSC SP Awardees Schools – In-School Verification Form

IC 211163 under ICR 202512-0915-003 · OMB 0915-0146.

Documents and Forms

Document Name Document Type
Form 2C NHSC SP Awardees Schools – In-School Verification Form Form and Instruction
Form 2C NHSC SP Awardees - In-School Verification Form NHSC SP Awardees Schools – In-School Verification Form Form and Instruction
2C NHSC SP Awardees - In-School Verification Form 0915 0146 ISV Form - Screenshots.docx Form and Instruction
2C NHSC SP Awardees - In-School Verification Form 0915 0146 ISV Form - Screenshots.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NHSC SP Awardees Schools â In-School Verification Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 62.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2C	NHSC SP Awardees - In-School Verification Form	0915 0146 ISV Form - Screenshots.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Public Health Service National Health Service Corps Scholarship/Loan Repayment Participants Records System	FR Citation: 58 FR 12968

Number of Respondents: 1,275	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,100	3,900	1,200
Annual IC Time Burden (Hours)	510	-90	600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.

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