HRSA Logo Bureau of Clinician Recruitment & Service Information System (BCRSIS) HHS Logo
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Welcome to the BCRSIS Banking Module

If you receive an award, all payments will be made by electronic transfer of funds to a banking institution. We must have applicant banking information available to generate timely awards. You will be ineligible for an award if you do not provide your banking information using this system and if you do not submit the “Receipt of Submission” which is the hardcopy of the banking information you submit through this system.

To help ensure the accuracy of the banking information in our electronic records, and timely automated processing, we also require the electronic submission of the banking information. You will need the following information available in order to fill out the banking form; Financial Institution Name and Address, Financial Institution's 9-digit ABA Routing Number for Transfer of Funds, Depositor Account Title, Depositor Account Number and the Type of Account (Checking or Savings).

Please note that the electronic submission of this information does not substitute for the paper submission required for in the application guidance. All electronic information will be transmitted and stored in a secure environment. For applicants not receiving an award, the banking information will be destroyed (paper and electronic versions) twelve months from the date of the notification letter.
 

WARNING: Any person who knowingly makes a false statement or a misrepresentation on this application shall be subject to a fine or to imprisonment of not more than 5 years, or both, under provision of the United Stated criminal code. I have read this statement and understand its contents.
 
 
 

Privacy Act Notification Statement
General
This information is provided pursuant to the Privacy Act of 1974 (Public Law 94-579) of December 31, 1974, as amended, to individuals supplying information for inclusion in a system of records.
Authority - Section 338A of the Public Health Service Act.; Section 338B of the Public Health Service Act.; Section 738 of the Public Health Service Act.; Section 846 of the Public Health Service Act.; Section 11703 of the Native Hawaiian Health Improvement Act.

Purpose and Uses
The purpose of the Bureau of Clinician Recruitment and Service (BCRS) is to assist in the recruitment and retention of health professionals who are dedicated to providing health care to underserved populations. The information you provide will be used to evaluate your eligibility for participating in the BCRS programs. In addition, the BCRS may obtain a credit bureau report for purposes of determining your eligibility. A participant’s Contract, application and related data, documentation, and correspondences are maintained in a system of records to be used within the Department of Health and Human Services to monitor BCRS-related activities. The information may also be disclosed outside the Department, as permitted by the Privacy Act and Freedom of Information Act, to the Congress, the National Archives, the General Accounting Office, pursuant to court order and various routine uses.

Effects of Nondisclosure
Disclosure of the information sought is voluntary; however, if not submitted, an application will be considered incomplete and you will not be eligible for funding.