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 FY 2017 NHSC SP Application Content.pdf
Instruction
NHHSP - Acceptance/Verification of Good Standing Report Removed 0 0 0 Form and Instruction 1 NHHSP - Acceptance/Verification of Good Standing Report
NHSC SP Authorization to Release Information Modified 1800 180 0 Form and Instruction 1 FY 2017 NHSC SP Authorization to Release.docx
NHSC SP Letters of Recommendation Modified 3600 1800 0 Form and Instruction 1 FY 2017 NHSC SP Recommendation Letter Email Instructions.docx
NHSC SP – Acceptance/Verification of Good Standing Report Modified 1800 450 0 Form and Instruction 1 FY 2017 NHSC SP Verification of Good Standing.docx
NHSC SP – Data Collection Worksheet Modified 400 400 0 Form and Instruction 1 NHSC SP Data Collection Worksheet Form.pdf
NHSC SP – Enrollment Verification Form Modified 1200 600 0 Form and Instruction 1 NHSC SP Enrollment Verification Form.pdf
NHSC SP – Post Graduate Training Verification Form Modified 100 50 0 Form and Instruction 1 FY 2017 NHSC Post Graduate Training Verification.pdf
NHSC SP – Receipt of Exceptional Financial Need Scholarship Modified 200 50 0 Form and Instruction 1 FY 2017 NHSC SP Verification of Exceptional Financial Need Scholarship.docx
NHSC SP – Verification of Disadvantaged Background Modified 300 75 0 Form and Instruction 1 FY 2017 NHSC SP Disadvantaged Background.docx
NHSC Students to Service Program Application Modified 100 200 0 Form and Instruction 1 FY 2017 NHSC S2S LRP Application Content.pdf
Instruction
Native Hawaiian Health Scholarship Program Application Modified 1360 528 0 Form and Instruction 1 NHHSP 2017-2018 Online Application and Forms.docx
Instruction
Form 2 NHHSP Letters of Recommendation Forms.docx
Form 3 NHHSP Authorization to Release Information.docx
Form 4 NHHSP Verification of Good Standing.docx
S2S LRP – Authorization to Release Information Modified 100 10 0 Form and Instruction 1 FY 2017 NHSC S2S LRP Authorization to Release.docx
S2S LRP - Letters of Recommendation Modified 200 100 0 Form and Instruction 1 FY 2017 NHSC S2S LRP Preceptor Letter of Recommendation Instructions.docx
Form and Instruction 2 FY 2017 NHSC S2S LRP Additional Letter of Recommendation Instructions.docx
S2S LRP - Post Graduate Training Verification Form Removed 0 0 0 Form and Instruction 1 S2S LRP - Post Graduate Training Verification Form
S2S LRP - Receipt of Exceptional Financial Need Scholarship Removed 0 0 0 Form 1 S2S LRP - Receipt of Exceptional Financial Need Scholarship
S2S LRP - Verification of Disadvantaged Background Modified 25 6 0 Form and Instruction 1 FY 2017 NHSC S2S LRP Disadvantaged Background.docx
S2S LRP – Acceptance/Verification of Good Standing Report Modified 100 25 0 Form and Instruction 1 FY 2017 NHSC S2S LRP Verification of Good Standing.docx
Total burden requested under this ICR: 13085 8074 0  
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