OMB control number

The National Health Service Corps Scholarship Program, Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program

OMB 0915-0146 · HHS/HSA.

OMB 0915-0146

The NHSC SP, NHSC S2S LRP, and the NHHSP provide scholarships or loan repayment to qualified students who are pursuing primary care health professions education and training. In return, students agree to provide primary health care services in medically underserved communities located in federally designated Health Professional Shortage Areas once they are fully trained and licensed health professionals. Awards are made to applicants who demonstrate the greatest potential for successful completion of their education and training as well as commitment to provide primary health care services to communities of greatest need. The information from program applications, forms, and supporting documentation is used to select the best qualified candidates for these competitive awards, and to monitor program participants’ enrollment in school, postgraduate training, and compliance with program requirements.

The latest form for The National Health Service Corps Scholarship Program, Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program expires 2029-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1A NHSC Scholarship Program Application Form and Instruction
Form 2C NHSC S2S LRP - Essay Form and Instruction
Form 1B NHSC S2S LRP - Proof of Citizenship Form and Instruction
Form 1B NHSC S2S LRP - Proof of Citizenship Form and Instruction
Form 1D NHSC SP Essay Form and Instruction
Form 1C NHSC SP - Proof of Citizenship Form and Instruction
Form 4G NHHSP Letters of Reccomendation Form and Instruction
Form 4F NHHSP Graduation Documentation Form Form and Instruction
Form 4E NHHSP Change in Program Curriculum Form Form and Instruction
Form 4D NHHSP Scholar Enroll Verification Form Form and Instruction
Form 4C NHHSP Acceptance Verification of Good Standing Form Form and Instruction
Form 4C NHHSP Acceptance/Verification of Good Standing Report Form and Instruction
Form 4B NHHSP Authorization to Release Information Form and Instruction
Form 4A NHHSP Program Application (User Guide) Form and Instruction
Form 4A Native Hawaiian Health Scholarship Program Application Form and Instruction
Form 3G NHSC S2S LRP - Verification of Disadvantaged Background Status Form and Instruction
Form 3D NHSC S2S LRP - Acceptance Verification of Good Standing Form Form and Instruction
Form 3E NHSC S2S LRP Authorization to Release Information Form.pdf Form and Instruction
Form 3D-Preceptor NHSC S2S LRP - Preceptor Instructions Form and Instruction
Form 3D-Instructions NHSC S2S LRP - Letters of Recommendations - Instructions Form and Instruction
Form 3-1 NHSC S2S LRP Application Screenshots.docx Form and Instruction
Form 2C NHSC SP Awardees - In-School Verification Form Form and Instruction
Form 2B NHSC SP Awardees - Post Graduate Training Verification Form and Instruction
Form 2A NHSC SP Awardees - Data Collection Worksheet Form Form and Instruction
Form 1G NHSC SP - Verification of Disadvantaged Background Status Form and Instruction
Form 1F NHSC SP-Acceptance Verification of Good Standing Report Form and Instruction
Form 1E NHSC SP - Authorization to Release Information Form and Instruction
Form 1B NHSC SP - Letters of Recommendation Form and Instruction
0915-0146 BHW Scholarship Programs SS-A - 12052025.docx Supporting Statement A
NHSC Scholarship Program Application Form and Instruction
NHSC Scholarship Program Application Form and Instruction
NHSC S2S LRP - Essay Form and Instruction
NHSC S2S LRP - Essay Form and Instruction
NHSC S2S LRP - Proof of Citizenship Form and Instruction
NHSC S2S LRP - Proof of Citizenship Form and Instruction
NHSC SP - Essay Form and Instruction
NHSC SP - Essay Form and Instruction
NHSC SP - Proof of Citizenship Form and Instruction
NHSC SP - Proof of Citizenship Form and Instruction
NHHSP Letters of Reccomendation Form and Instruction
NHHSP Letters of Reccomendation Form and Instruction
NHHSP Graduation Documentation Form Form and Instruction
NHHSP Graduation Documentation Form Form and Instruction
NHHSP Change in Program Curriculum Form Form and Instruction
NHHSP Change in Program Curriculum Form Form and Instruction
NHHSP Scholar Enrollment Verification Form Form and Instruction
NHHSP Scholar Enrollment Verification Form Form and Instruction
NHHSP Acceptance/Verification of Good Standing Report Form and Instruction
NHHSP Acceptance/Verification of Good Standing Report Form and Instruction
NHHSP Authorization to Release Information Form and Instruction
NHHSP Authorization to Release Information Form and Instruction
Native Hawaiian Health Scholarship Program Application Form and Instruction
Native Hawaiian Health Scholarship Program Application Form and Instruction
S2S LRP - Verification of Disadvantaged Background Form and Instruction
S2S LRP - Verification of Disadvantaged Background Form and Instruction
S2S LRP – Acceptance/Verification of Good Standing Report Form and Instruction
S2S LRP – Acceptance/Verification of Good Standing Report Form and Instruction
S2S LRP – Authorization to Release Information Form and Instruction
S2S LRP – Authorization to Release Information Form and Instruction
S2S LRP - Letters of Recommendation Form and Instruction
S2S LRP - Letters of Recommendation Form and Instruction
S2S LRP - Letters of Recommendation Form and Instruction
NHSC Students to Service Repayment Program Application Form and Instruction
NHSC Students to Service Repayment Program Application Form and Instruction
NHSC SP Awardees Schools – In-School Verification Form Form and Instruction
NHSC SP Awardees Schools – In-School Verification Form Form and Instruction
NHSC SP Awardees Schools – Post Graduate Training Verification Form Form and Instruction
NHSC SP Awardees Schools – Post Graduate Training Verification Form Form and Instruction
NHSC SP Awardees Schools – Data Collection Worksheet Form and Instruction
NHSC SP Awardees Schools – Data Collection Worksheet Form and Instruction
NHSC SP – Verification of Disadvantaged Background Form and Instruction
NHSC SP – Verification of Disadvantaged Background Form and Instruction
NHSC SP – Acceptance/Verification of Good Standing Report Form and Instruction
NHSC SP – Acceptance/Verification of Good Standing Report Form and Instruction
NHSC SP Authorization to Release Information Form and Instruction
NHSC SP Authorization to Release Information Form and Instruction
NHSC SP Letters of Recommendation Form and Instruction
NHSC SP Letters of Recommendation Form and Instruction

All Historical Document Collections

202512-0915-003 Approved without change	Revision of a currently approved collection	2025-12-16
202305-0915-001 Approved with change	Revision of a currently approved collection	2023-05-09
202006-0915-004 Approved without change	Revision of a currently approved collection	2020-06-17
202004-0915-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-04-21
201706-0915-003 Approved without change	Revision of a currently approved collection	2017-06-15
201609-0915-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-09-29
201404-0915-001 Approved with change	Revision of a currently approved collection	2014-04-23
201101-0915-003 Approved without change	Revision of a currently approved collection	2011-01-29
200801-0915-002 Approved without change	Reinstatement with change of a previously approved collection	2008-01-08
200702-0915-003 Withdrawn and continue	Revision of a currently approved collection	2007-02-20
200307-0915-005 Approved without change	Extension without change of a currently approved collection	2003-07-23
200005-0915-001 Approved without change	Extension without change of a currently approved collection	2000-05-08
199612-0915-002 Approved without change	Revision of a currently approved collection	1996-12-18
199506-0915-004 Approved without change	Reinstatement without change of a previously approved collection	1995-06-14
199504-0915-001 Improperly submitted	Extension without change of a currently approved collection	1995-04-03
199201-0915-003 Approved without change	Revision of a currently approved collection	1992-01-31
199101-0915-002 Approved without change	New collection (Request for a new OMB Control Number)	1991-01-28

OMB Details

NHSC Scholarship Program Application

Federal Enterprise Architecture: Health - Health Care Services

Form 1A

NHSC Scholarship Program Application

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.