Information Collection

PHS Supplements to Application for Federal Assistance (SF 424)

IC 6843 under ICR 200212-0920-005 · OMB 0920-0428.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0428 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

PHS Supplements to Application for Federal Assistance (SF 424)

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	CDC.124(E)	No	No
Form	OPHS-1	No	No
Form	PHS-5161-1	No	No
Form	SF-424	No	No
Form	CDC.0113	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,456

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,989	16,989
Annual IC Time Burden (Hours)	42,691	42,691
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.