PS LRP Employment Verification Form

Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP) and the Pediatric Specialty Loan Repayment Program

OMB: 0906-0058

IC ID: 260337

Documents and Forms
Information Collection (IC) Details

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PS LRP Employment Verification Form
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 8 PS LRP Employment Verification Form PS LRP EVF.docx Yes Yes Fillable Fileable

Health Health Care Services

 

500 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 500 0 0 0 0 500
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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