Information Collection

S2S LRP – Acceptance/Verification of Good Standing Report

IC 211167 under ICR 202606-0915-003 · OMB 0915-0146.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3D NHSC S2S LRP - Acceptance Verification of Good Standing Form S2S LRP – Acceptance/Verification of Good Standing Report	Form and Instruction
Form 3D NHSC S2S LRP - Acceptance Verification of Good Standing Form S2S LRP – Acceptance/Verification of Good Standing Report	Form and Instruction
3D NHSC S2S LRP - Acceptance Verification of Good Standing 0915 0146 - NHSC S2S V. of Good Standing.pdf	Form and Instruction
3D NHSC S2S LRP - Acceptance Verification of Good Standing 0915 0146 - NHSC S2S V. of Good Standing.pdf	Form and Instruction

IC Title:

S2S LRP â Acceptance/Verification of Good Standing Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	3D				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 348

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	348	348
Annual IC Time Burden (Hours)	87	87
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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