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NHSC and NURSE Corps Interest Capture Form
The NHSC and NURSE Corps Interest Capture Form
OMB: 0915-0337
IC ID: 195587
OMB.report
HHS/HSA
OMB 0915-0337
ICR 202305-0915-002
IC 195587
( )
Documents and Forms
Document Name
Document Type
Form 1
NHSC and NURSE Corps Interest Capture Form
Form
1 NHSC NC Interest Capture Form
NHSC-NC Interest Capture Form.docx
Form
1 NHSC NC Interest Capture Form
NHSC-NC Interest Capture Form.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
NHSC and NURSE Corps Interest Capture Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
NHSC NC Interest Capture Form
NHSC-NC Interest Capture Form.docx
Yes
Yes
Fillable Fileable
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:
16,144
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
16,144
0
13,744
0
0
2,400
Annual IC Time Burden (Hours)
404
0
344
0
0
60
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.
