Information Collection

User Access Request Form for EPIC System Portal (ESP)

IC 276653 under ICR 202507-1117-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OMB #1117-0NEW User Access Request Form for EPIC System Portal (ESP)	Form and Instruction
Form OMB #1117-0NEW ESP User Access Request Form User Access Request Form for EPIC System Portal (ESP)	Form and Instruction
OMB #1117-0NEW ESP User Access Request Form New User Request Form.pdf	Form and Instruction
OMB #1117-0NEW ESP User Access Request Form New User Request Form with Burden Statement - 2 (1).pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.12

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	OMB #1117-0NEW				Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Substance Control

Privacy Act System of Records

Title: User Access Request Form for EPIC System Portal (ESP)

FR Citation: 90 FR 51409

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	1,000	1,000
Annual IC Time Burden (Hours)	116	116
Annual IC Cost Burden (Dollars)	4,000	4,000

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.

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