Information Collection

School Enrollment Verification Form

IC 240469 under ICR 202508-0915-002 · OMB 0915-0301.

Documents and Forms

Document Name Document Type
Form 2 School Enrollment Verification Form Form
Form 2 School Enrollment Verification Form School Enrollment Verification Form Form
2 School Enrollment Verification Form 2_School Enrollment Verification Form.docx Form
2 School Enrollment Verification Form 2_School Enrollment Verification Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	School Enrollment Verification Form	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2	School Enrollment Verification Form	2_School Enrollment Verification Form.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: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,200	-800	2,000
Annual IC Time Burden (Hours)	396	-264	660
Annual IC Cost Burden (Dollars)	0	0	0

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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