Information Collection

NOAA Teacher-At-Sea Program Participant Application and Health Services Questionnaire

IC 4196 under ICR 200702-0648-010 · OMB 0648-0283.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0648-0283 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NOAA Teacher-At-Sea Program Participant Application and Health Services Questionnaire	Form and Instruction
NOAA Teacher At Sea Program Participant Application 0283 revised form a.pdf	Form and Instruction
NOAA Health Services Questionnaire 0283 NOAA Health Services Questionnaire.pdf	Form and Instruction

IC Title:

NOAA Teacher-At-Sea Program Participant Application and Health Services Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	NOAA Teacher At Sea Program Participant Application	0283 revised form a.pdf		Yes	No	Fillable Printable
Form and Instruction	NA	NOAA Health Services Questionnaire	0283 NOAA Health Services Questionnaire.pdf		No		Paper Only

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 125

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	125	-295	420
Annual IC Time Burden (Hours)	156	-153	309
Annual IC Cost Burden (Dollars)	280	-720	1,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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