Form 2-2 NHSC SP Post Graduate Training Verification Form

OMB Number: 0915-0146
Expiration Date: XX/XX/20XX

Public Burden Statement: The purpose of the NHSC SP, NHSC S2S LRP, and the NHHSP is to provide scholarships or loan
repayment to qualified students who are pursuing primary care health professions education and training. In return, students
agree to provide primary health care services at approved facilities located in designated Health Professional Shortage Areas
(HPSAs) once they are fully trained and licensed health professionals. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control
number for this information collection is 0915-0146 and it is valid until XX/XX/202X. This information collection is required to
obtain or retain a benefit (NHSC SP: Section 338A of the PHS Act and Section 338C-H of PHS Act; NHSC S2S LRP: Section 338B
of the PHS Act and Section 331(i) of the PHS Act; NHHSP: The Native Hawaiian Health Care Improvement Act of 1992, as
amended [42 U.S.C. 11709]. Public reporting burden for this collection of information is estimated to average xx hours per
response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B,
Rockville, Maryland, 20857 or paperwork@hrsa.gov.