Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual Status Report Unchanged 200 50 0 Form IHS-856-16
Change of Name or Address Unchanged 20 3 0 Form IHS-856-22
Change of Status Unchanged 50 21 0 Form IHS-856-10
Course Curriculum Verification Removed 0 0 0 Form IHS-856-6
Delinquent Federal Debt Removed 0 0 0 Form IHS-856-5
Extern Site Preference Request Removed 0 0 0 Form IHS-856-17
Faculty/Advisor Evaluation Removed 0 0 0 Form IHS-856-24
Faculty/Employer Evaluation Removed 0 0 0 Form IHS-856-3
Health Professions Contract Unchanged 225 38 0 Form IHS 818
IHS Scholarship Program Application New 850 850 0 Other-Web Site Apps
Lost Stipend Payment Modified 10 1 0 Form IHS-856-19
Notice of Impending Graduation Unchanged 170 28 0 Form IHS-856-13
Notification of Academic Problem Modified 20 3 0 Form IHS-856-9
Notification of Deferment Program Modified 60 8 0 Form IHS-856-14
Placement Update Unchanged 170 31 0 Form IHS-856-15
Preferred Placement Unchanged 150 75 0 Form IHS-856-12
Recipient's Initial Program Progress Report Modified 800 107 0 Form ihs-856-8
Request for Approval of Deferment Modified 60 8 0 Form HS-856-11
Request for Credit Validation Unchanged 30 3 0 Form IHS-856-23
Request for Extern Travel Reimbursement Removed 0 0 0 Form IHS-856-18
Scholarship Program Agreement Modified 60 10 0 Form IHS-817
Summer School Request Unchanged 100 10 0 Form IHS-856-21
Verification of Acceptance or Decline of Award Modified 300 40 0
Total burden requested under this ICR: 3275 1286 0  
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