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

ICR 202305-0915-001

OMB: 0915-0146

Federal Form Document

Forms and Documents

Document Name	Status
Form 1A NHSC Scholarship Program Application Form and Instruction	Modified
Form 4H NHHSP Letters of Reccomendation Form and Instruction	New
Form 4G NHHSP Graduation Documentation Form Form and Instruction	Modified
Form 4F NHHSP Change in Program Curriculum Form Form and Instruction	Modified
Form 4E NHHSP Scholar Enrollment Verification Form Form and Instruction	Modified
Form 4C NHHSP Acceptance/Verification of Good Standing Report Form and Instruction	Modified
Form 4B NHHSP Authorization to Release Information Form and Instruction	Modified
Form 4A Native Hawaiian Health Scholarship Program Application Form and Instruction	Modified
Form 3E S2S LRP - Verification of Disadvantaged Background Form and Instruction	Modified
Form 3D S2S LRP – Acceptance/Verification of Good Standing Report Form and Instruction	Modified
Form 3C S2S LRP – Authorization to Release Information Form and Instruction	Modified
Form 3B-Instructions S2S LRP - Letters of Recommendation Form and Instruction	Modified
Form 3-1 NHSC Students to Service Repayment Program Application Form and Instruction	Modified
Form 2E NHSC SP Awardees Schools – Enrollment Verification Form Form and Instruction	Modified
Form 2D NHSC SP Awardees Schools – Post Graduate Training Verification Form Form and Instruction	Modified
Form 2C NHSC SP Awardees Schools – Data Collection Worksheet Form and Instruction	Modified
Form 2B NHSC SP – Verification of Disadvantaged Background Form and Instruction	Modified
Form 4-2 NHHSP Letters of Recommendation Form and Instruction	Removed
Form 1D NHSC SP – Acceptance/Verification of Good Standing Report Form and Instruction	Modified
Form 1C NHSC SP Authorization to Release Information Form and Instruction	Modified
Form 1B NHSC SP Letters of Recommendation Form and Instruction	Modified
Revised BHW Scholarship Programs Supporting Statement.docx Supporting Statement A	2023-05-08

IC Document Collections

IC ID	Document Title	Status
6375	NHSC Scholarship Program Application Form and Instruction	Modified
260078	NHHSP Letters of Reccomendation Form and Instruction	New
242296	NHHSP Graduation Documentation Form Form and Instruction	Modified
242295	NHHSP Change in Program Curriculum Form Form and Instruction	Modified
242294	NHHSP Scholar Enrollment Verification Form Form and Instruction	Modified
242293	NHHSP Acceptance/Verification of Good Standing Report Form and Instruction	Modified
242292	NHHSP Authorization to Release Information Form and Instruction	Modified
211172	Native Hawaiian Health Scholarship Program Application Form and Instruction	Modified
211169	S2S LRP - Verification of Disadvantaged Background Form and Instruction	Modified
211167	S2S LRP – Acceptance/Verification of Good Standing Report Form and Instruction	Modified
211166	S2S LRP – Authorization to Release Information Form and Instruction	Modified
211165	S2S LRP - Letters of Recommendation Form and Instruction	Modified
211164	NHSC Students to Service Repayment Program Application Form and Instruction	Modified
211163	NHSC SP Awardees Schools – Enrollment Verification Form Form and Instruction	Modified
211162	NHSC SP Awardees Schools – Post Graduate Training Verification Form Form and Instruction	Modified
211161	NHSC SP Awardees Schools – Data Collection Worksheet Form and Instruction	Modified
211160	NHSC SP – Verification of Disadvantaged Background Form and Instruction	Modified
211159	NHHSP Letters of Recommendation Form and Instruction	Removed
211157	NHSC SP – Acceptance/Verification of Good Standing Report Form and Instruction	Modified
211155	NHSC SP Authorization to Release Information Form and Instruction	Modified
211154	NHSC SP Letters of Recommendation Form and Instruction	Modified