Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
NHHSP Acceptance/Verification of Good Standing Report Modified 40 10 0 Form and Instruction 4C NHHSP Acceptance Verification of Good Standing Form
NHHSP Authorization to Release Information Modified 310 78 0 Form and Instruction 4B NHHSP Authorization to Release Information
NHHSP Change in Program Curriculum Form Modified 80 20 0 Form and Instruction 4F NHHSP Change in Program Curriculum Form
NHHSP Graduation Documentation Form Modified 40 10 0 Form and Instruction 4G NHHSP Graduation Documentation Form
NHHSP Letters of Reccomendation New 620 155 0 Form and Instruction 4H NHHSP Letters of Reccomendation
NHHSP Letters of Recommendation Removed 0 0 0 Form and Instruction 4-2 NHHSP Instructions - Letters of Recommendation.pdf
NHHSP Scholar Enrollment Verification Form Modified 300 150 0 Form and Instruction 4E NHHSP Scholar Enroll Verification Form
NHSC SP Authorization to Release Information Modified 2575 258 0 Form and Instruction 1C Authorization to Release Information
NHSC SP Awardees Schools – Post Graduate Training Verification Form Modified 100 50 0 Form and Instruction 2D Post Graduate Training Verification
NHSC SP Awardees Schools – Data Collection Worksheet Modified 400 400 0 Form and Instruction 2C Data Collection Worksheet Form
NHSC SP Awardees Schools – Enrollment Verification Form Modified 1200 600 0 Form and Instruction 2E Enrollment Verification Form
NHSC SP Letters of Recommendation Modified 5150 5150 0 Form and Instruction 1B Letters of Recommendation
NHSC SP – Acceptance/Verification of Good Standing Report Modified 2575 644 0 Form and Instruction 1D NHSC SP-Acceptance Verification of Good Standing Report
NHSC SP – Verification of Disadvantaged Background Modified 615 154 0 Form and Instruction 2B Verification of Disadvantaged Background Status
NHSC Scholarship Program Application Modified 2575 5150 0 Form and Instruction 1A NHSC Scholarship Program Application
NHSC Students to Service Repayment Program Application Modified 284 568 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 4A NHHSP Program Application (User Guide)
S2S LRP – Authorization to Release Information Modified 284 28 0 Form and Instruction 3C NHSC S2S LRP Authorization to Release Information Form.pdf
S2S LRP - Letters of Recommendation Modified 284 568 0 Form and Instruction 3B-Instructions Letters of Recommendations-Instructions
Form and Instruction 3B-Preceptor 3B
S2S LRP - Verification of Disadvantaged Background Modified 84 21 0 Form and Instruction 3E Verification of Disadvantaged Background Status
S2S LRP – Acceptance/Verification of Good Standing Report Modified 284 71 0 Form and Instruction 3D Acceptance Verification of Good Standing Form
Total burden requested under this ICR: 18110 14705 0  
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