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 Unchanged 1800 3600 0 Form and Instruction 1 FY 2017 NHSC SP Application Content.pdf
Instruction
NHSC SP Authorization to Release Information Unchanged 1800 180 0 Form and Instruction 1 FY 2017 NHSC SP Authorization to Release.docx
NHSC SP Letters of Recommendation Unchanged 3600 1800 0 Form and Instruction 1 FY 2017 NHSC SP Recommendation Letter Email Instructions.docx
NHSC SP – Acceptance/Verification of Good Standing Report Unchanged 1800 450 0 Form and Instruction 1 FY 2017 NHSC SP Verification of Good Standing.docx
NHSC SP – Data Collection Worksheet Unchanged 400 400 0 Form and Instruction 1 NHSC SP Data Collection Worksheet Form.pdf
NHSC SP – Enrollment Verification Form Unchanged 1200 600 0 Form and Instruction 1 NHSC SP Enrollment Verification Form.pdf
NHSC SP – Post Graduate Training Verification Form Unchanged 100 50 0 Form and Instruction 1 FY 2017 NHSC Post Graduate Training Verification.pdf
NHSC SP – Receipt of Exceptional Financial Need Scholarship Unchanged 200 50 0 Form and Instruction 1 FY 2017 NHSC SP Verification of Exceptional Financial Need Scholarship.docx
NHSC SP – Verification of Disadvantaged Background Unchanged 300 75 0 Form and Instruction 1 FY 2017 NHSC SP Disadvantaged Background.docx
NHSC Students to Service Program Application Unchanged 100 200 0 Form and Instruction 1 FY 2017 NHSC S2S LRP Application Content.pdf
Instruction
Native Hawaiian Health Scholarship Program Application Unchanged 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 Unchanged 100 10 0 Form and Instruction 1 FY 2017 NHSC S2S LRP Authorization to Release.docx
S2S LRP - Letters of Recommendation Unchanged 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 - Verification of Disadvantaged Background Unchanged 25 6 0 Form and Instruction 1 FY 2017 NHSC S2S LRP Disadvantaged Background.docx
S2S LRP – Acceptance/Verification of Good Standing Report Unchanged 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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