Information Collection

NOAA Teacher-At-Sea Program Participant Application and Health Services Questionnaire

IC 4196 under ICR 200809-0648-005 · OMB 0648-0283.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0648-0283 can be found here:

Documents and Forms

Document Name Document Type
NOAA Teacher-At-Sea Program Participant Application and Health Services Questionnaire Form and Instruction
0283 NHSQ INSTRUCTIONS Rev Oct 08.doc Instruction
NOAA Teacher At Sea Program Participant Application 0283 revised form a.pdf Form and Instruction
NOAA Health Services Questionnaire 0283 NOAA NHSQ Final Version August 2008 Highlighted What is New.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NOAA Teacher-At-Sea Program Participant Application and Health Services Questionnaire	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	NOAA Teacher At Sea Program Participant Application	0283 revised form a.pdf	Yes	No	Fillable Printable
Form	NA	NOAA Health Services Questionnaire	0283 NOAA NHSQ Final Version August 2008 Highlighted What is New.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			0283 NHSQ INSTRUCTIONS Rev Oct 08.doc	Yes	No	Printable Only

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 125	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Previously Approved
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	156	156
Annual IC Cost Burden (Dollars)	280	280

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.