IHS Loan Application

Indian Health Service Loan Repayment Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0014 can be found here:

Documents and Forms

Document Name Document Type
IHS Loan Application Form and Instruction
IHS Loan Repayment Application IHS-loan repayment handbook 11-4-08.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	IHS Loan Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.5(d)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	IHS Loan Repayment Application	IHS-loan repayment handbook 11-4-08.pdf		No	No	Paper Only

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 510	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	510	-1,615	2,125
Annual IC Time Burden (Hours)	153	-1,229	1,382
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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