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⚠️ Notice: This information collection may be referencing outdated material.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
Scholarship Application Form
IHS Form 856 IHS Form 856.pdf Form

Information Collection (IC) Details

IC Title:	Scholarship Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	NA	IHS Form 856	IHS Form 856.pdf		No	No	Paper Only

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 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,500	1,500
Annual IC Time Burden (Hours)	-1,500	1,500
Annual IC Cost Burden (Dollars)	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.