3206-0246 Student Scholarship for Services Form

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CyberCorps®: Scholarship for Service

Official Website of the U.S. Office of Personnel Management

OMB # 3206-0246
Expires: 11/4/2024

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STUDENTS: REGISTRATION

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*First Name

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Brandon

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Middle Name or Initial

*Last Name
Dempsey2
Suffix (e.g., Jr., III or M.D.)

*Social Security Number

*Confirm Social Security Number
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*Date of Birth (Example: mm/dd/yyyy)

*University/College Attending
Florida State University
*Degree Program
Bachelor of Arts
*Major
Applied Mathematics
Minor
Computer & Network Security
*Initial Funding Semester/Quarter (mm/yyyy)

*Expected Graduation Date (mm/dd/yyyy)
04/01/2024
*Email Address
[email protected]
*Alternate Email Address

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By selecting Submit, you acknowledge the Privacy act statement.
Submit

Privacy act statement

Privacy act statement
Pursuant to 5 U.S.C. § 552a(e)(3), this privacy statement
serves to inform you of why the U.S. Office of Personnel
Management (OPM) is requesting the information in this
registration form.
Authority: The National Science Foundation Act of 1950, as
amended, authorizes the National Science Foundation (NSF)
to promote and advance scientific progress in the United
States by competitively awarding grants and cooperative
agreements for research and education in the sciences,
mathematics and engineering. The CyberCorps: Scholarship
for Service (SFS) program, as a program within the Division
of Undergraduate Education at NSF, was established under
this charter. OPM's authority to collect information in
support of SFS program activities is derived from the above
law through a memorandum of understanding (MOU)
between NSF and OPM that tasks OPM with providing the
operational framework for the federal placement and
tracking of students throughout the academic phase and
post-graduation federal employment obligation. Executive
Order 9397 as amended by Executive Order 13478 authorizes
the collection of the Social Security number to identify
individual records in federal personnel records systems.
Purpose and routine uses: The purpose and routine uses of
collected information are specific to the type of user (scholar,
principal investigator or agency official) registering on the
site, as follows:

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Scholar
Purpose: The information collected from you (the
scholarship recipient) is used to verify your eligibility
and ensure compliance with program requirements. The
information is made available to SFS program
administrators, the principal investigator (PI) at your
participating academic institution and participating
employers (federal agencies, independent agencies,
government corporations, commissions, quasi-official
agencies or federally funded research development
centers) for the purpose of internship and postgraduation placement. It may also be used for studies
and statistics that will not identify you.
Routine Uses: The information requested here may be
shared externally as a “routine use” and is subject to
verification via paper, electronic media or through the
use of computer matching programs with participating
employers (federal agencies, independent agencies,
government corporations, commissions, quasi-official
agencies or federally funded research development
centers) in order to assist you in meeting program
commitment requirements. A complete list of the
routine uses can be found in the system of records
notice associated with this application, OPM Internal 18,
CyberCorps: Scholarship for Service, 79 FR 42604, July
18, 2014. The information may also be shared with the
Department of Treasury in the event you default on
program requirements and scholarship funding received
must be reimbursed to the U.S. federal government.
Consequences of failure to provide information:
Furnishing the data requested is voluntary, but failure to
do so will delay or make it impossible for us to process
your registration. Registering in the SFS portal and
completing an online resume is required for program
participation.

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Principal investigator
Purpose: The information collected from you as a
principal investigator (PI) is used to register scholarship
recipients into the program and to monitor scholar
progress toward meeting program requirements. NSF
and OPM will have access to participating scholars’
records, and information provided by you about your
program will enable interested individuals to inquire
about, and vie for, SFS program scholarships. It may
also be used for studies and statistics that will not
identify you.
Routine Uses: The information requested here may be
shared externally as a “routine use” and is subject to
verification via paper or electronic media records. The
information collected is as follows: (1) the PI’s full name;
(2) the name of the educational institution; (3) the
department or branch; (4) the institution’s address; (5)
phone and fax numbers; and (6) the PI’s email address.
This information will be made available to all site
visitors. A complete list of the routine uses can be found
in the system of records notice associated with this
application, OPM Internal 18, CyberCorps Scholarship
for Service, 79 FR 42604, July 18, 2014.
Consequences of failure to provide information:
Furnishing the data requested is voluntary, but failure to
do so will prevent your school from being listed as a
participating institution on the SFS website, and you will
not be able to meet the terms of your grant.
Agency official
Purpose: The information collected is used to allow
agency officials system access to identify participating
scholarship recipients for potential employment
opportunities. Agency officials may also opt in to allow
participating scholars and academic officials access to
their contact information.
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Routine uses: The information requested on this form
from you as an agency official may be shared externally
as a “routine use” and is subject to verification via paper
or electronic media records. The information collected
is as follows: (1) the name of the organization; (2) the
name of the sub-agency or subdivision; (3) the
registrant’s full name; (4) the organization’s address; (5)
phone and fax numbers; and (6) the registrant’s email
address. This information is made available to
participating scholars, principal investigators (PIs) and
registered agency officials. The website also records the
number of times a participating agency official views
participating scholar resumes. A complete list of the
routine uses can be found in the system of records
notice associated with this application, OPM Internal 18,
CyberCorps Scholarship for Service, 79FR 42604, July
18, 2014.
Consequences of failure to provide information:
Furnishing the data requested is voluntary, but failure to
do so will prevent you from being granted access to
information about participating scholars and their
availability for placement with your agency.
Public reporting burden
The public reporting burden to complete this information
collection is estimated at 5 to 30 minutes per response,
depending on the user type and activity: For each new
scholar, we estimate the initial registration to take
approximately 30 minutes. For each existing active scholar,
we estimate annual maintenance of their profile and
employment verification to take 15 minutes. For academic
officials, we estimate the registration of new scholars to take
approximately 15 minutes and the maintenance and review
of active scholars to take 5 minutes per activity. These
burden estimates include time for reviewing instructions,
searching data sources, gathering and maintaining the data
needed and completing and reviewing the collected
information. An agency may not conduct or sponsor, and a
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person is not required to respond to, a collection of
information unless it displays a currently valid OMB control
number and expiration date. Send comments regarding this
burden estimate or any other aspect of this collection
information, including suggestions for reducing this burden,
to: U.S. Office of Personnel Management, Scholarship for
Service Program, Attn: OMB Number (3206-0246), 1900 E
Street NW, Washington, DC 20415-7900. Current information
regarding this collection of information—including all
background materials—can be found at
https:/www.reginfo.gov/public/do/PRAMain by using the
search function to enter either the title of the collection
(Scholarship For Service (SFS) Program Internet Site) or the
OMB Control Number (3206-0246).

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