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Evaluation Of Applicant (for Residency Training)

IC 165534 under ICR 198107-0915-004 · OMB 0915-0003.

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EVALUATION OF APPLICANT (FOR RESIDENCY TRAINING)
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HSA-201 No No


    

1,000 0
   
Individuals or Households
 
   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 1,000 0 0 0 0 1,000
Annual IC Time Burden (Hours) 175 0 0 0 0 175
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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