The National Health Service Corps Scholarship Program, Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program

OMB 0915-0146

Administered by HRSA’s Bureau of Health Workforce (BHW), the National Health Service Corps (NHSC) Scholarship Program (SP), NHSC Students to Service Loan Repayment Program (S2S LRP), and the Native Hawaiian Health Scholarship Program (NHHSP), 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 in underserved communities located in federally designated Health Professional Shortage Areas (HPSAs) once they are fully trained and licensed health professionals. Awards are made to applicants who demonstrate the greatest potential for successful completion of their education and training as well as commitment to provide primary health care services to communities of greatest need. The program applications, forms, and supporting documentation are used to collect necessary information from applicants and participants that will facilitate in the selection of the best qualified candidates for these competitive awards, and to monitor participants’ enrollment in school or in postgraduate training.

The latest form for The National Health Service Corps Scholarship Program, Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program expires 2023-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1A NHSC Scholarship Program Application Form and Instruction
Form 4H NHHSP Letters of Reccomendation Form and Instruction
Form 4G NHHSP Graduation Documentation Form Form and Instruction
Form 4F NHHSP Change in Program Curriculum Form Form and Instruction
Form 4E NHHSP Scholar Enrollment Verification Form Form and Instruction
Form 4C NHHSP Acceptance/Verification of Good Standing Report Form and Instruction
Form 4B NHHSP Authorization to Release Information Form and Instruction
Form 4A Native Hawaiian Health Scholarship Program Application Form and Instruction
Form 3E S2S LRP - Verification of Disadvantaged Background Form and Instruction
Form 3D S2S LRP – Acceptance/Verification of Good Standing Report Form and Instruction
Form 3C S2S LRP – Authorization to Release Information Form and Instruction
Form 3B-Instructions S2S LRP - Letters of Recommendation Form and Instruction
Form 3-1 NHSC Students to Service Repayment Program Application Form and Instruction
Form 2E NHSC SP Awardees Schools – Enrollment Verification Form Form and Instruction
Form 2D NHSC SP Awardees Schools – Post Graduate Training Verification Form Form and Instruction
Form 2C NHSC SP Awardees Schools – Data Collection Worksheet Form and Instruction
Form 2B NHSC SP – Verification of Disadvantaged Background Form and Instruction
Form 4-2 NHHSP Letters of Recommendation Form and Instruction
Form 1D NHSC SP – Acceptance/Verification of Good Standing Report Form and Instruction
Form 1C NHSC SP Authorization to Release Information Form and Instruction
Form 1B NHSC SP Letters of Recommendation Form and Instruction
Revised BHW Scholarship Programs Supporting Statement.docx Supporting Statement A
NHSC Scholarship Program Application Form and Instruction
NHHSP Letters of Reccomendation Form and Instruction
NHHSP Graduation Documentation Form Form and Instruction
NHHSP Change in Program Curriculum Form Form and Instruction
NHHSP Scholar Enrollment Verification Form Form and Instruction
NHHSP Acceptance/Verification of Good Standing Report Form and Instruction
NHHSP Authorization to Release Information Form and Instruction
Native Hawaiian Health Scholarship Program Application Form and Instruction
S2S LRP - Verification of Disadvantaged Background Form and Instruction
S2S LRP – Acceptance/Verification of Good Standing Report Form and Instruction
S2S LRP – Authorization to Release Information Form and Instruction
S2S LRP - Letters of Recommendation Form and Instruction
NHSC Students to Service Repayment Program Application Form and Instruction
NHSC SP Awardees Schools – Enrollment Verification Form Form and Instruction
NHSC SP Awardees Schools – Post Graduate Training Verification Form Form and Instruction
NHSC SP Awardees Schools – Data Collection Worksheet Form and Instruction
NHSC SP – Verification of Disadvantaged Background Form and Instruction
NHHSP Letters of Recommendation Form and Instruction
NHSC SP – Acceptance/Verification of Good Standing Report Form and Instruction
NHSC SP Authorization to Release Information Form and Instruction
NHSC SP Letters of Recommendation Form and Instruction

All Historical Document Collections

202305-0915-001 Approved with change	Revision of a currently approved collection	2023-05-09
202006-0915-004 Approved without change	Revision of a currently approved collection	2020-06-17
202004-0915-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-04-21
201706-0915-003 Approved without change	Revision of a currently approved collection	2017-06-15
201609-0915-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-09-29
201404-0915-001 Approved with change	Revision of a currently approved collection	2014-04-23
201101-0915-003 Approved without change	Revision of a currently approved collection	2011-01-29
200801-0915-002 Approved without change	Reinstatement with change of a previously approved collection	2008-01-08
200702-0915-003 Withdrawn and continue	Revision of a currently approved collection	2007-02-20
200307-0915-005 Approved without change	Extension without change of a currently approved collection	2003-07-23
200005-0915-001 Approved without change	Extension without change of a currently approved collection	2000-05-08
199612-0915-002 Approved without change	Revision of a currently approved collection	1996-12-18
199506-0915-004 Approved without change	Reinstatement without change of a previously approved collection	1995-06-14
199504-0915-001 Improperly submitted	Extension without change of a currently approved collection	1995-04-03
199201-0915-003 Approved without change	Revision of a currently approved collection	1992-01-31
199101-0915-002 Approved without change	New collection (Request for a new OMB Control Number)	1991-01-28

OMB Details

NHSC Scholarship Program Application

Federal Enterprise Architecture: Health - Health Care Services

Form 1-1

NHSC SP Application Screenshots.docx

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.