Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Authorization for Disclosure of Loan Information Form Unchanged 7150 715 0 Form and Instruction 2
NHSC Comprehensive Behavioral Health Services Checklist Unchanged 4400 572 0 Form and Instruction 6
NHSC Site Application (including recertification) Unchanged 4070 2035 0 Form and Instruction 7
Privacy Act Release Authorization Form Unchanged 303 30 0 Form and Instruction 3
Private Practice Option Form Unchanged 330 33 0 Form and Instruction 5
The National Health Service Corps (NHSC) Loan Repayment Program Application Unchanged 9020 9020 0 Form and Instruction 1
Instruction
Verification of Disadvantaged Background Form Unchanged 660 330 0 Form and Instruction 4
Total burden requested under this ICR: 25933 12735 0  
To view an IC, click on IC Title