Information Collection

ANA Consultant and Evaluator Qualifications Form

IC 10119 under ICR 201411-0970-006 · OMB 0970-0265.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0265 can be found here:

Documents and Forms

Document Name Document Type
Form 1 ANA Consultant and Evaluator Qualifications Form Form and Instruction
1 ANA Panel Reviewer Profile Form ANA Panel Reviewer Profile Form2015(newdraft).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ANA Consultant and Evaluator Qualifications Form	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 and Instruction	1	ANA Panel Reviewer Profile Form	ANA Panel Reviewer Profile Form2015(newdraft).pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: ANA Consultant and Evaluator Qualifications Form	FR Citation: 72 FR 37784

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	150	150
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.