Information Collection List

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