Annual Status Report

Application for Participation in the IHS Scholarship Program

Documents and Forms

Document Name Document Type
Form IHS-856-16 Annual Status Report Form
IHS-856-16 Annual Status Report IHS-856-16 ANNUAL STAT RPT.pdf Form
IHS-856-16 Annual Status Report Annual Status Report_Final.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Status Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	IHS-856-16	Annual Status Report	Annual Status Report_Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: IHS Scholarship Program	FR Citation: 74 FR 50222

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	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.