Information Collection

Online Application (OA)

IC 212509 under ICR 201808-1625-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form USCGA-AIM1 AIM Scholarship Request Form Online Application (OA)	Form
Form USCGA-AIM2 Travel Form Online Application (OA)	Form and Instruction
Form USCGA-AIM3 Medical History and Clearance Form Online Application (OA)	Form
1625-0121 Instr_r0_2017.doc	Instruction
1625-0121_AIM Application_Registration.pdf	Other-Online AIM Application
USCGA-AIM1 AIM Scholarship Request Form AIM Scholarship Request (AIM 1) 2019.pdf	Form
USCGA-AIM2 Travel Form AIM Travel Form (AIM 2) 2019.pdf	Form and Instruction
USCGA-AIM3 Medical History and Clearance Form AIM Medical History and Clearance (AIM 3) 2019.pdf	Form

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	USCGA-AIM1	AIM Scholarship Request Form	AIM Scholarship Request (AIM 1) 2019.pdf	www.uscga.edu / [email protected]	Yes	Yes	Fillable Fileable
Form and Instruction	USCGA-AIM2	Travel Form	AIM Travel Form (AIM 2) 2019.pdf	www.uscga.edu / [email protected]	Yes	Yes	Fillable Fileable
Form	USCGA-AIM3	Medical History and Clearance Form	AIM Medical History and Clearance (AIM 3) 2019.pdf	www.uscga.edu / [email protected]	Yes	Yes	Fillable Fileable Signable
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

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
	Approved	Change Due to Potential Violation of the PRA
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.