Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application for Participation in the National Health Service Corps Scholarship Program Modified 1800 3600 0 Form and Instruction 1 NHSC Scholarship Program Application
Data Collection Worksheet - School/Site Form Removed 0 0 0 Form NHSC_SP_003 Data Collection Worksheet
Deferment Request Form - Participant Form Removed 0 0 0 Form NHSC_SP_005 Deferment Request Form
NHHSP - Acceptance/Verification of Good Standing Report New 1110 278 0 Form and Instruction 1 NHHSP - Acceptance/Verification of Good Standing Report
NHSC SP Authorization to Release Information New 1800 180 0 Form and Instruction 1 NHSC SP Authorization to Release Information
NHSC SP Letters of Recommendation New 3600 1800 0 Instruction
NHSC SP – Acceptance/Verification of Good Standing Report New 1800 450 0 Form and Instruction 1 NHSC SP – Acceptance/Verification of Good Standing Report
NHSC SP – Data Collection Worksheet New 400 400 0 Form and Instruction 1 NHSC SP – Data Collection Worksheet
NHSC SP – Enrollment Verification Form New 1200 600 0 Form and Instruction 1 NHSC SP – Enrollment Verification Form
NHSC SP – Post Graduate Training Verification Form New 200 100 0 Form and Instruction 1 NHSC SP – Post Graduate Training Verification Form
NHSC SP – Receipt of Exceptional Financial Need Scholarship New 200 50 0 Form 1 NHSC SP – Receipt of Exceptional Financial Need Scholarship
NHSC SP – Verification of Disadvantaged Background New 300 75 0 Form 1 NHSC SP – Verification of Disadvantaged Background
NHSC Students to Service Program Application New 100 200 0 Form and Instruction 1 NHSC Students to Service Program Application
Native Hawaiian Health Scholarship Program Application New 250 250 0 Form and Instruction 1 Native Hawaiian Health Scholarship Program Application
S2S LRP – Authorization to Release Information New 100 10 0 Form and Instruction 1 S2S LRP – Authorization to Release Information
S2S LRP - Letters of Recommendation New 200 100 0 Instruction
S2S LRP - Post Graduate Training Verification Form New 150 75 0 Form and Instruction 1 S2S LRP - Post Graduate Training Verification Form
S2S LRP - Receipt of Exceptional Financial Need Scholarship New 4 1 0 Form 1 S2S LRP - Receipt of Exceptional Financial Need Scholarship
S2S LRP - Verification of Disadvantaged Background New 25 6 0 Form 1 S2S LRP - Verification of Disadvantaged Background
S2S LRP – Acceptance/Verification of Good Standing Report New 100 25 0 Form and Instruction 1 S2S LRP – Acceptance/Verification of Good Standing Report
Six-Month Service Obligation Verification Form - School/Sites Forms Removed 0 0 0 Form NHSC_SP_004 Six-Month Service Obligation Verification Form
Total burden requested under this ICR: 13339 8200 0  
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