Information Collection

NHSC SP – Verification of Vulnerable Background

IC 211160 under ICR 202606-0915-003 · OMB 0915-0146.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1G NHSC SP Verification of Vulnerable Background Status Form NHSC SP – Verification of Vulnerable Background	Form and Instruction
Form 1G NHSC SP Verification of Vulnerable Background Status Form NHSC SP – Verification of Vulnerable Background	Form and Instruction
1G NHSC SP Verification of Vulnerable Background Status For NHSC SP Verification of Vulnerable Background Status Form.docx	Form and Instruction
1G NHSC SP Verification of Vulnerable Background Status For NHSC SP Verification of Vulnerable Background Status Form.docx	Form and Instruction
NHSC SP Verification of Vulnerable Background Status Form (Redline).pdf NHSC SP Verification of Vulnerable Background Status Form (Redline 06302026)	IC Document
NHSC SP Verification of Vulnerable Background Status Form (Redline).pdf NHSC SP Verification of Vulnerable Background Status Form (Redline 06302026)	IC Document

IC Title:

NHSC SP â Verification of Vulnerable Background

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:

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	1G				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: 615

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	Previously Approved
Annual Number of Responses for this IC	615	615
Annual IC Time Burden (Hours)	154	154
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NHSC SP Verification of Vulnerable Background Status Form (Redline 06302026)		06/30/2026

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

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