Information Collection

PHS 398 Paper

IC 37814 under ICR 202408-0925-001 · OMB 0925-0001.

Documents and Forms

Document Name Document Type
Form 1 PHS 398 Paper Form
1 Application Attachment 3 PHS 398_forms_FORMS-I.pdf Form
1 Application Attachment 3 PHS 398_forms_FORMS-I.pdf Form
2 Application Attachment 4 phs398 instructions_FORMS-I.docx Form
2 Application Attachment 4 phs398 instructions_FORMS-I.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PHS 398 Paper	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Application	Attachment 3 PHS 398_forms_FORMS-I.pdf		Yes	No	Paper Only
Form	2	Application	Attachment 4 phs398 instructions_FORMS-I.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,247	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,247	4,247
Annual IC Time Burden (Hours)	148,645	148,645
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.