Scholarship Application

Application for Participation in the IHS Scholarship Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0006 can be found here:

Documents and Forms

Document Name Document Type
Form multiple forms Scholarship Application Form and Instruction
multiple forms Student Handbook Scholarship_Handbook_OMB.pdf Form and Instruction
multiple forms Application Handbook Scholarship_Applicant_Handbook_OMB.pdf Form and Instruction
856.pdf form ihs-856 IC Document

Information Collection (IC) Details

IC Title:	Scholarship Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 2 CFR 3506

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	multiple forms	Student Handbook	Scholarship_Handbook_OMB.pdf		Yes	No	Fillable Printable
Form and Instruction	multiple forms	Application Handbook	Scholarship_Applicant_Handbook_OMB.pdf		Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: IHS Scholarship Program	FR Citation: 72 FR 5446

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,500	-15,830	17,330
Annual IC Time Burden (Hours)	1,500	-4,036	5,536
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
form ihs-856	856.pdf	12/04/2007

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