IHS Loan Application

Indian Health Service Loan Repayment Program

OMB: 0917-0014

IC ID: 6573

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

IHS Loan Application 0917-0014
 
No Unchanged
 
Voluntary
 
5 CFR 1320

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0014 Educational and Professional Background IHS Loan Repayment Application - Educational and Professional Background.pdf http://www.ihs.gov/loanrepayment/applynow/ Yes Yes Fillable Fileable Signable
Form and Instruction 0917-0014 Financial Information IHS Loan Repayment Application - Financial Information.pdf http://www.ihs.gov/loanrepayment/applynow/ Yes Yes Fillable Fileable Signable
Form and Instruction 0917-0028 General Applicant Information IHS Loan Repayment Application - General Applicant Information.pdf http://www.ihs.gov/loanrepayment/applynow/ Yes Yes Fillable Fileable Signable

Education Higher Education

 

1,999 0
   
Individuals or Households
 
   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 1,999 0 0 0 0 1,999
Annual IC Time Burden (Hours) 2,999 0 0 0 0 2,999
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
60 Day Federal Register Notice for 0917-0014, Loan Repayment Program 60 Day FRN for OMB No. 0917-0014, 02-05-2015.docx 06/22/2015
0917-0014, Published 60 Day Federal Register Notice, Loan Repayment Program 60 day FR Publication 04-28-15 (2).pdf 06/22/2015
0917-0014, 30 Day Federal Register Notice for Loan Repayment Program FINAL 30 Day FRN for OMB No 0917-0014 05-27-15- DRA Final - TCLAY.docx 06/22/2015
OMB No. 0917-0014, Published Federal Register Notice for Loan Repayment Program 30 Day Federal Register Notice for IHS Loan Repayment Program, June 11, 2015.pdf 06/22/2015
Supporting Statement for OMB No. 0917-0014, Loan Repayment Program FINAL_LRP_Supporting_Statement_6-22-15 DRA.docx 06/23/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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