Information Collection

Student Application Form High School Students

IC 219961 under ICR 201602-0925-004 · OMB 0925-0738.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0738 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Student Application Form High School Students	Form and Instruction
1 Attachment 1 Student Application Form Attachment 1- Student Application Form.pdf	Form and Instruction

IC Title:

Student Application Form High School Students

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	1	Attachment 1 Student Application Form	Attachment 1- Student Application Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	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.