Information Collection

User Access Request Form for EPIC System Portal (ESP)

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OMB #1117-0NEW	ESP User Access Request Form	New User Request Form with Burden Statement - 2 (1).pdf		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 %

	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

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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