View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Application for Participation in the National Health Service Corps Scholarship Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	nhsc 0146	nhsc scholarship application	0146 scholarship form.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Public Health Service National Health Service Corps Scholarship/Loan Repayment Participants Records System	FR Citation: 58 FR 12968

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,800	0	-1,300	0	0	3,100
Annual IC Time Burden (Hours)	1,950	0	-1,150	0	0	3,100
Annual IC Cost Burden (Dollars)	0	0	-8,000	0	0	8,000

Documents for IC

Title	Document	Date Uploaded
Bulletin	0146 bulletin 07.doc

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.