Student Stipend Agreement (Amendment)

General Admissions Application (Long and Short) and Stipend Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0100 can be found here:

Documents and Forms

Document Name Document Type
Form 119-25-4 Student Stipend Agreement (Amendment) Form
119-25-4 Student Stipend Agreement (Amendment) 119-25-4 Previously 75-3A.pdf Form

Information Collection (IC) Details

IC Title:	Student Stipend Agreement (Amendment)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	119-25-4	Student Stipend Agreement (Amendment)	119-25-4 Previously 75-3A.pdf		Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title: Student Application and Registration (SARRS)	FR Citation: 69 FR 59609

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	33	33
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.