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 Authorization to Release Information Modified 200 50 0 Form and Instruction 4B
NHHSP Change in Program Curriculum Form Modified 40 10 0 Form and Instruction 4E
NHHSP Graduation Documentation Form Modified 40 10 0 Form and Instruction 4F
NHHSP Letters of Reccomendation Modified 400 100 0 Form and Instruction 4G
NHHSP Scholar Enrollment Verification Form Modified 160 80 0 Form and Instruction 4D
NHSC S2S LRP - Essay New 348 348 0 Form and Instruction 2C
NHSC S2S LRP - Proof of Citizenship New 348 35 0 Form and Instruction 1B
NHSC SP - Essay New 3100 3100 0 Form and Instruction 1D
NHSC SP - Proof of Citizenship New 3100 620 0 Form and Instruction 1C
NHSC SP Authorization to Release Information Modified 3100 310 0 Form and Instruction 1E
NHSC SP Awardees Schools – Post Graduate Training Verification Form Modified 383 192 0 Form and Instruction 2B
NHSC SP Awardees Schools – Data Collection Worksheet Modified 550 550 0 Form and Instruction 2A
NHSC SP Awardees Schools – In-School Verification Form Modified 5100 510 0 Form and Instruction 2C
NHSC SP Letters of Recommendation Modified 6200 6200 0 Form and Instruction 1B
NHSC SP – Acceptance/Verification of Good Standing Report Modified 3100 775 0 Form and Instruction 1F
NHSC SP – Verification of Disadvantaged Background Modified 615 154 0 Form and Instruction 1G
NHSC Scholarship Program Application Modified 3100 6200 0 Form and Instruction 1A
NHSC Students to Service Repayment Program Application Modified 348 696 0 Form and Instruction 3-1
Native Hawaiian Health Scholarship Program Application Modified 200 400 0 Form and Instruction 4A
S2S LRP – Authorization to Release Information Modified 348 35 0 Form and Instruction 3E
S2S LRP - Letters of Recommendation Modified 348 696 0 Form and Instruction 3D-Instructions
Form and Instruction 3D-Preceptor
S2S LRP - Verification of Disadvantaged Background Modified 115 29 0 Form and Instruction 3G
S2S LRP – Acceptance/Verification of Good Standing Report Modified 348 87 0 Form and Instruction 3D
Total burden requested under this ICR: 31631 21197 0  
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