PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Application Cover Letter (Reconciiation)
New
60
150
0
Other-no form-provided by grantee
Application Cover Letter (initial)
Modified
60
20
0
Other-provided by grantee
CFO Cover Letter (Initial and Reconciliation)
Modified
120
40
0
Other-no form-provided by grantee
Conversation Record (Resident FTE Assessment)
Modified
60
60
0
Form
CR
Conversation Record (FTE Resident Assessment)
Exhibit 1 (Resident FTE Assessment)
Modified
60
210
0
Other-no form-provided by grantee
Exhibit 2 (FTE Resident Assessment)
New
60
20
0
Other-no form-provided by grantee
Exhibit 2 (Initial and Reconciliation)
Modified
120
40
0
Other-no form-provided by grantee
Exhibit 3 (FTE Resident Assessment)
New
60
210
0
Other-no form-provided by grantee
Exhibit 3 (Initial and Reconciliation)
Modified
120
220
0
Other-no form-provided by grantee
Exhibit 4 (FTE Resident Assessment)
New
60
20
0
Other-no form-provided by grantee
Exhibit 4 (Initial and Reconciliation)
Modified
120
40
0
Other-no form-provided by grantee
Exhibit C (Resident FTE Assessment)
Modified
60
210
0
Form
C
Exhibit C (FTE Resident Assessment)
Exhibit F (Resident FTE Assessment)
Modified
60
90
0
Other-no form-provided by grantee
Exhibit N (Resident FTE Assessment)
Modified
60
210
0
Form
N
Exhibit N (FTE Resident Assessment)
Exhibit O(1) (Resident FTE Assessment)
Modified
60
210
0
Form
O(1)
Exhibit O(1) (FTE Resident Assessment)
Exhibit O(2) (Resident FTE Assessment)
Modified
60
1800
0
Form
O2
Exhibit O(2) (FTE Resident Assessment)
Exhibit P (Resident FTE Assessment)
Modified
60
210
0
Form
P
Exhibit P (FTE Resident Assessment)
Exhibit P(2) (FTE Resident Assessment)
New
60
210
0
Other-no form-provided by grantee
Exhibit P(2) (Resident FTE Assessment)
Removed
0
0
0
Instruction
Exhibit S (Resident FTE Assessment)
Modified
60
210
0
Form
S
Exhibit S (FTE Resident Assessment)
Exhibit T (Resident FTE Assessment)
Modified
60
210
0
Other-no form-provided by grantee
Exhibit T(1) (Resident FTE Assessment)
Modified
60
15
0
Other-no form-provided by grantee
FTE Assessment Letter (Resident FTE Assessment)
Modified
60
15
0
Other-no form-provided by grantee
HRSA 99 (Initial and Reconcilation)
Modified
120
40
0
Form
99 I and R
HRSA 99 (Initial and Reconciliation)
HRSA 99-1 (Initial)
Modified
60
1590
0
Form
99-1 I
HRSA 99-1 (Initial)
HRSA 99-1 (Reconcilliation)
Modified
60
390
0
Form
99-1 R
HRSA 99-1 (Reconciliation)
HRSA 99-1 Supplemental (FTE Resident Assessment)
Modified
60
220
0
Form
99-1 S
HRSA 99-1 (Supplemental FTE Resident Assessment)
HRSA 99-2 (Initial)
Modified
60
580
0
Form
99-2 I
HRSA 99-2 (Initial)
HRSA 99-2 (Reconcilliation)
New
60
170
0
Form
99-2 R
HRSA 99-2 (Reconciliation)
HRSA 99-4 (Reconciliation)
Modified
60
750
0
Form
99-4 R
HRSA 99-4 (Reconciliation)
HRSA 99-5 (Initial and Reconciliation)
Modified
120
40
0
Form
99-5 I & R
HRSA 99-5 (Initial and Reconciliation)
Total burden requested under this ICR:
2160
8200
0
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