Information Collection

Online Application (OA)

IC 212509 under ICR 201802-1625-003 · OMB 1625-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1625-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1625-0121 Instr_r0_2017.doc	Instruction
1625-0121_AIM Application_Registration.pdf	Other-Online AIM Application
USCGA-AIM3 AIM Medical History and Clearance From AIM Medical History and Clearance rev 1_29_15.pdf	Form
USCGA-AIM2 AIM Scholarship Request Form AIM Scholarship Request.pdf	Form
USCGA-AIM1 AIM Travel Update Form AIM Travel Update Form.pdf	Form and Instruction

IC Title:

Online Application (OA)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			1625-0121 Instr_r0_2017.doc	Yes	Yes	Printable Only
Other-Online AIM Application			1625-0121_AIM Application_Registration.pdf	Yes	Yes	Fillable Fileable
Form	USCGA-AIM3	AIM Medical History and Clearance From	AIM Medical History and Clearance rev 1_29_15.pdf	Yes	Yes	Fillable Fileable Signable
Form	USCGA-AIM2	AIM Scholarship Request Form	AIM Scholarship Request.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	USCGA-AIM1	AIM Travel Update Form	AIM Travel Update Form.pdf	Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Water Transportation

Privacy Act System of Records

Title: Privacy Act of 1974; Department of Homeland Security United States Coast Guard DHS/USCG -- 027 Recruiting FIles

FR Citation: 76 FR 49494

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	6,000	6,000
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.