Profile Completion Instructions and Screenshots

Health Workforce Connector

Documents and Forms

Document Name Document Type
Form 2 Profile Completion Instructions and Screenshots Form
2 Profile Completion Profile Completion Instructions and Screenshots - Attachment E.docx Form
2 Profile Completion Profile Completion Instructions and Screenshots - Attachment E.docx Form

Information Collection (IC) Details

IC Title:	Profile Completion Instructions and Screenshots	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	2	Profile Completion	Profile Completion Instructions and Screenshots - Attachment E.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: 4,164	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
Annual Number of Responses for this IC	4,164	4,164
Annual IC Time Burden (Hours)	4,164	4,164
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.