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IHS Scholarship Program Application
Application for Participation in the IHS Scholarship Program
OMB: 0917-0006
IC ID: 240987
OMB.report
HHS/IHS
OMB 0917-0006
ICR 202310-0917-001
IC 240987
( )
Documents and Forms
Document Name
Document Type
SCHOLARSHIP PROGRAM WEB SITE APPLICATION.pdf
www.ihs.gov/scholarship
Other-Web Site Apps
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
Supporting_Statement_for_OMB_No__0917-0006 FINAL 3.29.20.docx
Supporting Statement
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
IHS Scholarship Program Application
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
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:
850
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
850
0
0
0
0
850
Annual IC Time Burden (Hours)
850
0
0
0
0
850
Annual IC Cost Burden (Dollars)
0
0
0
0
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.