PHS SUPPLEMENTS TO STANDARD A-102 FORMS

ICR 197901-0937-002

OMB: 0937-0011

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
165990 Migrated
ICR Details
0937-0011 197901-0937-002
Historical Active 197812-0937-006
HHS/OASH
PHS SUPPLEMENTS TO STANDARD A-102 FORMS
No material or nonsubstantive change to a currently approved collection   No
Emergency 01/30/1979
Approved with change 01/30/1979
Retrieve Notice of Action (NOA) 01/30/1979
  Inventory as of this Action Requested Previously Approved
06/30/1983 06/30/1983 06/30/1983
12,800 0 12,800
9,000 0 9,000
0 0 0

PHS SUPPLEMENTARY INSTRUCTIONS TO THE STANDARD OMB APPLICATION FORM WERE DEVELOPED TO EXTEND USE OF THE FORM TO ENCOMPASS NONGOVERNMENTAL APPLICANTS IN ADDITION TO GOVERNMENTAL APPLICANTS FOR HEALTH SERVICES AND TO AMPLIFY OR CLARIFY THE STANDARD INSTRUCTIONS TO MEET HEALTH PROGRAM NEEDS. APPROXIMATELY $1,137,000,000 OF PHS FUNDS WAS AWARDED IN FY 1979 ON THE BASIS OF THE STANDARD FORM AND SUPPLEMENTARY INSTRUCTIONS

None
None


No

1
IC Title Form No. Form Name
PHS SUPPLEMENTS TO STANDARD A-102 FORMS PHS 5159, PHS 5161-1,2, 5162-1,2, 5163, 5164, 5154, 5159, 5161-1

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 12,800 12,800 0 0 0 0
Annual Time Burden (Hours) 9,000 9,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/30/1979


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