Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Acknowledgment Card Removed 0 0 0 Form IHS-815
Address Change Notice Removed 0 0 0 Form IHS-816
Annual Status Report Modified 200 50 0 Form IHS-856-16
Application Checklist Removed 0 0 0 Form IHS-856-2
Change of Name or Address Modified 20 3 0 Form IHS-856-22
Change of Status Modified 50 21 0 Form IHS-856-10
Course Curriculum Verification Modified 1500 1050 0 Form IHS-856-6
Delinquent Federal Debt Modified 1500 200 0 Form IHS-856-5
Extern Site Preference Request Modified 300 40 0 Form IHS-856-17
Faculty/Advisor Evaluation Modified 3000 1250 0 Form IHS-856-24
Faculty/Employer Evaluation Modified 3000 1250 0 Form IHS-856-3
Health Professions Contract Modified 225 38 0 Form IHS-818
Lost Stipend Payment Modified 50 7 0 Form IHS-856-19
Narrative Statements Removed 0 0 0 Form IHS-856-4
Notice of Impending Graduation Modified 170 28 0 Form IHS-856-13
Notification of Academic Problem Modified 50 7 0 Form IHS-856-9
Notification of Deferment Program Modified 20 3 0 Form IHS-856-14
Placement Update Modified 170 31 0 Form IHS-856-15
Preferred Placement Modified 150 75 0 Form IHS-856-12
Recipient's Initial Program Progress Report Modified 1200 160 0 Form ihs-856-8
Request for Approval of Deferment Modified 20 3 0 Form HS-856-11
Request for Credit Validation Modified 30 3 0 Form IHS-856-23
Request for Extern Travel Reimbursement Modified 150 15 0 Form IHS-856-18
Request for Tutorial Assistance Removed 0 0 0 Form IHS-856-20
Scholarship Application Removed 0 0 0 Form NA
Scholarship Program Agreement Modified 175 29 0 Form IHS-817
Summer School Request Modified 100 10 0 Form IHS-856-21
Verification of Acceptance or Decline of Award Modified 500 67 0 Form IHS-856-7
Total burden requested under this ICR: 12580 4340 0  
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