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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
416-1
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
Instruction
Attachment 7A PHS 416-1 Instructions.doc
Yes
Yes
Paper Only
Form and Instruction
7B
Face Page
Attachment 7B PHS 416-1 Face Page 1.pdf
Yes
Yes
Paper Only
Form and Instruction
7C
Face Page 3
Attachment 7C PHS 416-1 Face Page 3.pdf
Yes
Yes
Paper Only
Form and Instruction
7D
Project Performance Site Format
Attachment 7D PHS 416-1 Project Performance Site Format Page.pdf
Yes
Yes
Paper Only
Form and Instruction
7E
Face Page 4
Attachment 7E PHS 416-1 Face Page 4.pdf
Yes
Yes
Paper Only
Form and Instruction
7F
SPONSOR/CO-SPONSOR BIOGRAPHICAL SKETCH
Attachment 7F PHS 416-1 Sponsor Biosketch Format Page.doc
Yes
Yes
Paper Only
Form and Instruction
7G
Checklist Form Page
Attachment 7G PHS 416-1 Checklist Form Page.pdf
Yes
Yes
Paper Only
Form and Instruction
7H
Continuation Page
Attachment 7H PHS 416-1 Continuation Page.pdf
Yes
Yes
Paper Only
Form and Instruction
7C
Face Page 2
Attachment 7C PHS 416-1 Face Page 2.pdf
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
30
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
30
0
0
0
0
30
Annual IC Time Burden (Hours)
300
0
0
0
0
300
Annual IC Cost Burden (Dollars)
0
0
0
0
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.