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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Acknowledgment Card
New
1500
50
0
Form
IHS-815
Acknowledgment Card
Address Change Notice
New
50
1
0
Form
IHS-816
Address Change Notice
Annual Status Report
Modified
200
50
0
Form
IHS-856-16
Annual Status Report
Application Checklist
Modified
1500
200
0
Form
IHS-856-2
Application Checklist
Change of Name or Address
Modified
50
7
0
Form
IHS-856-22
Change of Name or Address
Change of Status
Modified
50
21
0
Form
IHS-856-10
Change of Status
Checklist
Removed
0
0
0
Course Curriculum Verification
New
1500
1050
0
Form
IHS-856-6
Course Curriculum Verification
Delinquent Federal Debt
Modified
1500
200
0
Form
IHS-856-5
Delinquent Federal Debt
Extern Site Preference Request
Modified
125
17
0
Form
IHS-856-17
Extern Site Preference Request
Faculty/Advisor Evaluation
Modified
3000
2500
0
Form
IHS-856-24
Faculty-Advisor Evaluation
Faculty/Employer Evaluation
New
3000
2500
0
Form
IHS-856-3
Faculty/Employer Evaluation
Faculty/Employer Evaluation
Removed
0
0
0
Health Professions Contract
New
225
11
0
Form
IHS-818
Health Professions Contract
Lost Stipend Payment
Modified
50
7
0
Form
IHS-856-19
Lost Stipend Payment
Narrative Statements
Modified
1500
1125
0
Form
IHS-856-4
Narrative Statements
Notice of Impending Graduation
Modified
200
33
0
Form
IHS-856-13
Notice of Impending Graduation
Notification of Academic Problem
Modified
50
7
0
Form
IHS-856-9
Notification of Academic Problem
Notification of Deferment Program
Modified
50
7
0
Form
IHS-856-14
Notification of Deferment Program
Placement Update
Modified
200
37
0
Form
IHS-856-15
Placement Update
Preferred Placement
Modified
200
150
0
Form
IHS-856-12
Preferred Placement
Recipient's Initial Program Progress Report
Modified
400
53
0
Form
ihs-856-8
Recipient's Initial Program Progress Report
Request for Approval of Deferment
Modified
50
7
0
Form
HS-856-11
Request for Approval of Deferment
Request for Credit Validation
Modified
30
3
0
Form
IHS-856-23
Request for Credit Validation
Request for Extern Travel Reimbursement
Modified
125
13
0
Form
IHS-856-18
Request for Extern Travel Reimbursement
Request for Tutorial Assistance
Modified
150
20
0
Form
IHS-856-20
Request for Tutorial Assistance
Scholarship Application
Modified
1500
1500
0
Form
NA
IHS Form 856
Scholarship Program Agreement
New
175
9
0
Form
IHS-817
Scholarship Program Agreement
Summer School Request
Modified
75
8
0
Form
IHS-856-21
Summer School Request
Verification of Acceptance or Decline of Award
Modified
400
53
0
Form
IHS-856-7
Verification of Acceptance or Decline of Award
Total burden requested under this ICR:
17855
9639
0
To view an IC, click on IC Title