Information Collection List

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