Information Collection

Account Creation

IC 226284 under ICR 202309-0906-001 · OMB 0906-0031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0031 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Account Creation	Form
1 Account Creation Account Creation Instructions and Screenshots - Attachment D.docx	Form
1 Account Creation Account Creation Instructions and Screenshots - Attachment D.docx	Form

IC Title:

Account Creation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	1	Account Creation	Account Creation Instructions and Screenshots - Attachment D.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: HHS/HRSA/BHW Scholarship and Loan Repayment Program Records

FR Citation: 86 FR 28362

Number of Respondents: 5,008

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	Previously Approved
Annual Number of Responses for this IC	5,008	0	5,008
Annual IC Time Burden (Hours)	401	-4,164	4,565
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.