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Scholarships for Disadvantaged Students (SDS) Program Application Form
Scholarships for Disadvantaged Students Application Program Specific Form
OMB: 0915-0149
IC ID: 6377
OMB.report
HHS/HSA
OMB 0915-0149
ICR 201612-0915-003
IC 6377
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0149 can be found here:
2019-11-05 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Scholarships for Disadvantaged Students (SDS) Program Application Form
Form and Instruction
SDS Program Specific Form- Instructions.docx
Instruction
1 SDS Program Specific Form.pdf
SDS Program Specific Form.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Scholarships for Disadvantaged Students (SDS) Program Application Form
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 and Instruction
1
SDS Program Specific Form.pdf
SDS Program Specific Form.pdf
Yes
Yes
Fillable Fileable
Instruction
SDS Program Specific Form- Instructions.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
400
Number of Respondents for Small Entity:
40
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
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
400
0
0
0
0
400
Annual IC Time Burden (Hours)
5,200
0
0
0
0
5,200
Annual IC Cost Burden (Dollars)
0
0
0
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.