Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
NHHSP Acceptance/Verification of Good Standing Report New 30 8 0 Form and Instruction 4-4 NHHSP Accept-Ver. of Good Standing Report Form.pdf
NHHSP Authorization to Release Information New 310 78 0 Form and Instruction 4-3 NHHSP Authorization to Release Information Form.pdf
NHHSP Change in Program Curriculum Form New 60 15 0 Form and Instruction 4-6 NHHSP Change in Curriculum Form.pdf
NHHSP Graduation Documentation Form New 30 8 0 Form and Instruction 4-7 NHHSP Graduation Documentation Form.pdf
NHHSP Letters of Recommendation Modified 620 155 0 Form and Instruction 4-2 NHHSP Instructions - Letters of Recommendation.pdf
NHHSP Scholar Enrollment Verification Form New 225 113 0 Form and Instruction 4-5 NHHSP Scholar Enrollment Verification Form.pdf
NHSC SP Authorization to Release Information Modified 1889 189 0 Form and Instruction 1-3 NHSC SP Authorization to Release Information Form.pdf
NHSC SP Awardees Schools – Post Graduate Training Verification Form Modified 100 50 0 Form and Instruction 2-2 NHSC SP Post Graduate Training Verification Form.pdf
NHSC SP Awardees Schools – Data Collection Worksheet Modified 400 400 0 Form and Instruction 2-1 NHSC SP Data Collection Worksheet Form.pdf
NHSC SP Awardees Schools – Enrollment Verification Form Modified 1200 600 0 Form and Instruction 2-3 NHSC SP Enrollment Verification Form.pdf
NHSC SP Letters of Recommendation Modified 3778 3778 0 Other-Letters of Recommendation
NHSC SP – Acceptance/Verification of Good Standing Report Modified 1889 472 0 Form and Instruction 1-4 NHSC SP Accep Ver Good Standing Form.pdf
NHSC SP – Verification of Disadvantaged Background Modified 547 137 0 Other-Verification of Dis Background
NHSC Scholarship Program Application Modified 1889 3778 0 Form and Instruction 1-1 NHSC SP Application Screenshots.docx
NHSC Students to Service Repayment Program Application Modified 200 400 0 Form and Instruction 3-1 NHSC S2S LRP Application Screenshots.docx
Native Hawaiian Health Scholarship Program Application Modified 310 620 0 Form and Instruction 4-1 NHHSP Application.pdf
Instruction
S2S LRP – Authorization to Release Information Modified 200 20 0 Form and Instruction 3-3 NHSC S2S LRP Authorization to Release Information Form.pdf
S2S LRP - Letters of Recommendation Modified 400 400 0 Other-Preceptor L or R
Other-Addtnl L of R
S2S LRP - Verification of Disadvantaged Background Modified 70 18 0 Form and Instruction 3-5 NHSC S2S LRP Disadvantaged Background Form.pdf
S2S LRP – Acceptance/Verification of Good Standing Report Modified 200 50 0 Form and Instruction 3-4 NHSC S2S LRP Verification of Good Standing Form.pdf
Total burden requested under this ICR: 14347 11289 0  
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