Information Collection

Account Creation

IC 226284 under ICR 202603-0906-003 · OMB 0906-0031.

Documents and Forms

Document Name Document Type
Form A Account Creation Account Creation Form
Form B Profile Completion Instructions Account Creation Form
A Account Creation Account Creation Instructions - Attachment A.docx Form
B Profile Completion Instructions Profile Completion Instructions - Attachment B.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Account Creation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	A	Account Creation	Account Creation Instructions - Attachment A.docx		Yes	Yes	Fillable Fileable
Form	B	Profile Completion Instructions	Profile Completion Instructions - Attachment B.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: 5,330	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,330	322	5,008
Annual IC Time Burden (Hours)	5,440	5,039	401
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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