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Phs Supplements To Standard A-102 Forms
PHS SUPPLEMENTS TO STANDARD A-102 FORMS
OMB: 0937-0011
IC ID: 165987
OMB.report
HHS/OASH
OMB 0937-0011
ICR 197812-0937-004
IC 165987
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0937-0011 can be found here:
1983-11-07 - Reinstatement without change of a previously approved collection
1983-06-29 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PHS SUPPLEMENTS TO STANDARD A-102 FORMS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
PHS 5159
No
No
Form
PHS 5161-1,2
No
No
Form
PHS 5162-1,2
No
No
Form
PHS 5163
No
No
Form
PHS 5164
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,000
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
4,000
0
0
0
0
4,000
Annual IC Time Burden (Hours)
16,000
0
0
7,000
0
9,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.