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Lost Stipend Payment
Application for Participation in the IHS Scholarship Program
OMB: 0917-0006
IC ID: 183625
OMB.report
HHS/IHS
OMB 0917-0006
ICR 202310-0917-001
IC 183625
( )
Documents and Forms
Document Name
Document Type
Form IHS-856-19
Lost Stipend Payment
Form
IHS-856-19 Lost Stipend Payment
IHS-856-19 LOST STIPEND PYMT.pdf
Form
IHS-856-19 Lost Stipend Payment
IHS-856-19 LOST STIPEND PYMT.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Lost Stipend Payment
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
IHS-856-19
Lost Stipend Payment
IHS-856-19 LOST STIPEND PYMT.pdf
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Education
Subfunction:
Higher Education
Privacy Act System of Records
Title:
IHS Scholarship Program
FR Citation:
74 FR 50222
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
0
0
0
-10
0
10
Annual IC Time Burden (Hours)
0
0
0
-1
0
1
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.