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 is listed under ICR 202606-0915-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 1A NHSC Scholarship Program Application	Form and Instruction
Form 1A NHSC Scholarship Program Application	Form and Instruction
Form 2C NHSC S2S LRP - Essay	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 1D NHSC SP Essay	Form and Instruction
Form 1C NHSC SP - Proof of Citizenship	Form and Instruction
Form 1C NHSC SP - Proof of Citizenship	Form and Instruction
Form 4G NHHSP Letters of Reccomendation	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 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 4B NHHSP Authorization to Release Information	Form and Instruction
Form 4A NHHSP Program Application (User Guide)	Form and Instruction
Form 3G NHSC S2S LRP Verification of Vulnerable Background Status Form	Form and Instruction
Form 3G NHSC S2S LRP Verification of Vulnerable Background Status Form	Form and Instruction
Form 3D NHSC S2S LRP - Acceptance Verification of Good Standing Form	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 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 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 2B NHSC SP Awardees - Post Graduate Training Verification	Form and Instruction
Form 2A NHSC SP Awardees - Data Collection Worksheet Form	Form and Instruction
Form 2A NHSC SP Awardees - Data Collection Worksheet Form	Form and Instruction
Form 1G NHSC SP Verification of Vulnerable Background Status Form	Form and Instruction
Form 1G NHSC SP Verification of Vulnerable Background Status Form	Form and Instruction
Form 1F NHSC SP-Acceptance Verification of Good Standing Report	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
Non-Substantive Change Memo - 0915-0146.docx	Justification for No Material/Nonsubstantive Change
0915-0146 BHW Scholarship Programs SS-A - 12052025.docx	Supporting Statement A
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 Vulnerable Background	Form and Instruction
S2S LRP - Verification of Vulnerable 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
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 Vulnerable Background	Form and Instruction
NHSC SP – Verification of Vulnerable 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

Historical document collections
Reference	Filing	Received	Action
202606-0915-003	No material or nonsubstantive change to a currently approved collection	2026-07-01
202512-0915-003	Revision of a currently approved collection	2025-12-16	Approved without change
202305-0915-001	Revision of a currently approved collection	2023-05-09	Approved with change
202006-0915-004	Revision of a currently approved collection	2020-06-17	Approved without change
202004-0915-005	No material or nonsubstantive change to a currently approved collection	2020-04-21	Approved without change
201706-0915-003	Revision of a currently approved collection	2017-06-15	Approved without change
201609-0915-005	No material or nonsubstantive change to a currently approved collection	2016-09-29	Approved without change
201404-0915-001	Revision of a currently approved collection	2014-04-23	Approved with change
201101-0915-003	Revision of a currently approved collection	2011-01-29	Approved without change
200801-0915-002	Reinstatement with change of a previously approved collection	2008-01-08	Approved without change
200702-0915-003	Revision of a currently approved collection	2007-02-20	Withdrawn and continue
200307-0915-005	Extension without change of a currently approved collection	2003-07-23	Approved without change
200005-0915-001	Extension without change of a currently approved collection	2000-05-08	Approved without change
199612-0915-002	Revision of a currently approved collection	1996-12-18	Approved without change
199506-0915-004	Reinstatement without change of a previously approved collection	1995-06-14	Approved without change
199504-0915-001	Extension without change of a currently approved collection	1995-04-03	Improperly submitted
199201-0915-003	Revision of a currently approved collection	1992-01-31	Approved without change
199101-0915-002	New collection (Request for a new OMB Control Number)	1991-01-28	Approved without change

OMB Details

NHSC Scholarship Program Application

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
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.