The National Health Service Corps Scholarship Program In-School Worksheets

ICR 200011-0915-002

OMB: 0915-0250

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0915-0250 200011-0915-002
Historical Active
HHS/HSA
The National Health Service Corps Scholarship Program In-School Worksheets
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 02/20/2001
Retrieve Notice of Action (NOA) 11/16/2000
Forms should be spell-checked and proofread prior to submission to OMB. All typos, spelling errors, etc. should be corrected prior to printing of the forms.
  Inventory as of this Action Requested Previously Approved
06/30/2004 06/30/2004
1,350 0 0
276 0 0
0 0 0

The data collection forms are needed by the program in order to determine if the scholars are maintaining their status of eligibility that is stated in their contract and required by Federal statute and regulation.

None
None


No

1
IC Title Form No. Form Name
The National Health Service Corps Scholarship Program In-School Worksheets

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,350 0 0 1,350 0 0
Annual Time Burden (Hours) 276 0 0 276 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/16/2000


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