Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Authorization for Disclosure of Loan Information Form Unchanged 150 15 0 Form and Instruction 3
Privacy Act Release Authorization Form Unchanged 100 10 0 Form and Instruction 2
Private Practice Option Form Unchanged 300 30 0 Form and Instruction 4
The National Health Service Corps (NHSC) Loan Repayment Program Application Unchanged 8200 8200 0 Form and Instruction 1
Verification of Disadvantaged Background Form Unchanged 600 300 0 Form and Instruction 5
Total burden requested under this ICR: 9350 8555 0  
To view an IC, click on IC Title