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