Information Collection

NHSC SP - Proof of Citizenship

IC 278492 under ICR 202512-0915-003 · OMB 0915-0146.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0146 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1C NHSC SP - Proof of Citizenship	Form and Instruction
Form 1C NHSC SP - Proof of Citizenship NHSC SP - Proof of Citizenship	Form and Instruction
1C NHSC SP - Proof of Citizenship 0915 0146 - NHSC SP Citz. Screenshots.docx	Form and Instruction
1C NHSC SP - Proof of Citizenship 0915 0146 - NHSC SP Citz. Screenshots.docx	Form and Instruction

IC Title:

NHSC SP - Proof of Citizenship

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 62.6

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 and Instruction	1C				Yes	Yes	Fillable Fileable

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: 3,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,100	3,100
Annual IC Time Burden (Hours)	620	620
Annual IC Cost Burden (Dollars)	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.

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