IHS Scholarship Program 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⚠️ Notice: This information collection may be referencing outdated material.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 PROGRAM WEB SITE APPLICATION.pdf www.ihs.gov/scholarship Other-Web Site Apps
Supporting_Statement_for_OMB_No__0917-0006 FINAL 3.29.20.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	IHS Scholarship Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Site Apps			SCHOLARSHIP PROGRAM WEB SITE APPLICATION.pdf	www.ihs.gov/scholarship	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 850	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	850	850
Annual IC Time Burden (Hours)	850	850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Supporting_Statement_for_OMB_No__0917-0006 FINAL 3.29.20.docx	03/29/2020

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