Account Creation

Health Workforce Connector

Documents and Forms

Document Name Document Type
Form 1 Account Creation Form
1 Account Creation Account Creation Instructions and Screenshots - Attachment D.docx Form
1 Account Creation Account Creation Instructions and Screenshots - Attachment D.docx Form

Information Collection (IC) Details

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	1	Account Creation	Account Creation Instructions and Screenshots - Attachment D.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: 5,008	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	5,008	0	5,008
Annual IC Time Burden (Hours)	401	-4,164	4,565
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.