View Information Collection (IC)

View Information Collection (IC)

IC Title:	PHS-1813	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 21.28 42 CFR 21.34 42 CFR 21.22 42 CFR 21.58

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PHS-1813	REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH SERVICE COMMISSIONED CORPS	PHS 1813 Update 2023 (1).pdf		Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: PHS Commissioned Corps General Personnel Records	FR Citation: 63 FR 68596

Number of Respondents: 3,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	3,500	0	0	0	0	3,500
Annual IC Time Burden (Hours)	875	0	0	0	0	875
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.