Information Collection

PS LRP Privacy Act Release Authorization Form

IC 260336 under ICR 202512-0906-006 · OMB 0906-0058.

Documents and Forms

Document Name Document Type
Form 7 PS LRP Privacy Act Release Authorization Form PS LRP Privacy Act Release Authorization Form Form and Instruction
7 PS LRP Privacy Act Release Authorization Form PS LRP PARA Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PS LRP Privacy Act Release Authorization 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 and Instruction	7	PS LRP Privacy Act Release Authorization Form	PS LRP PARA Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09â15â0037, HHS/HRSA/BHW Scholarship and Loan Repayment Program Records	FR Citation: 86 FR 28362

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	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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