Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Authorization for Disclosure of Loan Information Form Modified 6500 650 0 Form and Instruction 3
NHSC Comprehensive Behavioral Health Services Checklist New 4000 520 0 Form and Instruction 6
NHSC Site Application (including recertification) New 3700 1850 0 Form and Instruction 7
Privacy Act Release Authorization Form Modified 275 28 0 Form and Instruction 2
Private Practice Option Form Modified 300 30 0 Form and Instruction 4
The National Health Service Corps (NHSC) Loan Repayment Program Application Modified 8200 8200 0 Form and Instruction 1
Verification of Disadvantaged Background Form Modified 600 300 0 Form and Instruction 5
Total burden requested under this ICR: 23575 11578 0  
To view an IC, click on IC Title