Information Collection

NSF 1458, Personal Information Form

IC 182105 under ICR 201101-3145-003 · OMB 3145-0177.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3145-0177 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1458 NSF 1458, Personal Information Form	Form and Instruction
1458 Personal Information Form 1458, Personal Information.pdf	Form and Instruction

IC Title:

NSF 1458, Personal Information Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 675

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1458	Personal Information Form	1458, Personal Information.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: NSF-19, Medical Examination Records for Service in the Polar Regions

FR Citation: 62 FR 59895

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,000	-500	3,500
Annual IC Time Burden (Hours)	750	-125	875
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.