Information Collection

398/424 Forms and Instructions (Electronic)

IC 182171 under ICR 200709-0925-002 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 BIOGRAPHICAL SKETCH 398/424 Forms and Instructions (Electronic)	Form
Form 2 BIOGRAPHICAL SKETCH Sample 398/424 Forms and Instructions (Electronic)	Form
Form 3 CDAF 398/424 Forms and Instructions (Electronic)	Form
Form 5 Checklist 398/424 Forms and Instructions (Electronic)	Form
Form 6 Continuation 398/424 Forms and Instructions (Electronic)	Form
Form 7 Enrollment 398/424 Forms and Instructions (Electronic)	Form
Form 8 Enrollment Report 398/424 Forms and Instructions (Electronic)	Form
Form 9 FP1 398/424 Forms and Instructions (Electronic)	Form
Form 10 FP1 Continued 398/424 Forms and Instructions (Electronic)	Form
Form 11 FP2 398/424 Forms and Instructions (Electronic)	Form
Form 12 FP3 398/424 Forms and Instructions (Electronic)	Form
Form 13 FP4 398/424 Forms and Instructions (Electronic)	Form
Form 14 FP5 398/424 Forms and Instructions (Electronic)	Form
Form 15 Labels 398/424 Forms and Instructions (Electronic)	Form
Form 16 NRSAFP3 398/424 Forms and Instructions (Electronic)	Form
Form 17 NRSAFP4 398/424 Forms and Instructions (Electronic)	Form
Form 18 NRSAFP5 398/424 Forms and Instructions (Electronic)	Form
Form 19 Other Support 398/424 Forms and Instructions (Electronic)	Form
Form 20 Performance Site 398/424 Forms and Instructions (Electronic)	Form
Form 21 Personal 398/424 Forms and Instructions (Electronic)	Form
Form 22 Personnel Report 398/424 Forms and Instructions (Electronic)	Form
Form 23 Resources 398/424 Forms and Instructions (Electronic)	Form
Form 24 Component 398/424 Forms and Instructions (Electronic)	Form
datatable2.doc	Instruction
datatable3.doc	Instruction
datatable4.doc	Instruction
datatable5.doc	Instruction
datatable6.doc	Instruction
datatable7a.doc	Instruction
datatable8a.doc	Instruction
datatable9a.doc	Instruction
datatable10.doc	Instruction
datatable11.doc	Instruction
datatable12a.doc	Instruction
datatable12b.doc	Instruction
DataTableInstruct.doc	Instruction
DataTableIntro.doc	Instruction
datatables1-12.doc	Instruction
phs398_Rev092007.doc	Instruction
SampleTables.doc	Instruction
datatable1.doc	Instruction
1 BIOGRAPHICAL SKETCH 9-07_biosketch.doc	Form
2 BIOGRAPHICAL SKETCH Sample 9-07_biosketchsample.doc	Form
3 CDAF 9-07_cdafp3.doc	Form
5 Checklist 9-07_checklist.doc	Form
6 Continuation 9-07_continuation.doc	Form
7 Enrollment 9-07_enrollment.doc	Form
8 Enrollment Report 9-07_enrollmentreport.doc	Form
9 FP1 9-07_fp1.doc	Form
10 FP1 Continued 9-07_fp1-cont.doc	Form
11 FP2 9-07_fp2.doc	Form
12 FP3 9-07_fp3.doc	Form
13 FP4 9-07_fp4.doc	Form
14 FP5 9-07_fp5.doc	Form
15 Labels 9-07_labels.doc	Form
16 NRSAFP3 9-07_nrsafp3.doc	Form
17 NRSAFP4 9-07_nrsafp4.doc	Form
18 NRSAFP5 9-07_nrsafp5.doc	Form
19 Other Support 9-07_othersupport.doc	Form
20 Performance Site 9-07_performancesite.doc	Form
21 Personal 9-07_personal.doc	Form
22 Personnel Report 9-07_personnelreport.doc	Form
23 Resources 9-07_resources.doc	Form
24 Component 398 component forms.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

398/424 Forms and Instructions (Electronic)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	BIOGRAPHICAL SKETCH	9-07_biosketch.doc	Yes	Yes	Paper Only
Form	2	BIOGRAPHICAL SKETCH Sample	9-07_biosketchsample.doc	Yes	Yes	Paper Only
Form	3	CDAF	9-07_cdafp3.doc	Yes	Yes	Paper Only
Instruction			datatable2.doc	Yes	Yes	Paper Only
Form	5	Checklist	9-07_checklist.doc	Yes	Yes	Paper Only
Form	6	Continuation	9-07_continuation.doc	Yes	Yes	Paper Only
Form	7	Enrollment	9-07_enrollment.doc	Yes	Yes	Paper Only
Form	8	Enrollment Report	9-07_enrollmentreport.doc	Yes	Yes	Paper Only
Form	9	FP1	9-07_fp1.doc	Yes	Yes	Paper Only
Form	10	FP1 Continued	9-07_fp1-cont.doc	Yes	Yes	Paper Only
Form	11	FP2	9-07_fp2.doc	Yes	Yes	Paper Only
Form	12	FP3	9-07_fp3.doc	Yes	Yes	Paper Only
Form	13	FP4	9-07_fp4.doc	Yes	Yes	Paper Only
Form	14	FP5	9-07_fp5.doc	Yes	Yes	Paper Only
Form	15	Labels	9-07_labels.doc	Yes	Yes	Paper Only
Form	16	NRSAFP3	9-07_nrsafp3.doc	Yes	Yes	Paper Only
Form	17	NRSAFP4	9-07_nrsafp4.doc	Yes	Yes	Paper Only
Form	18	NRSAFP5	9-07_nrsafp5.doc	Yes	Yes	Paper Only
Form	19	Other Support	9-07_othersupport.doc	Yes	Yes	Paper Only
Form	20	Performance Site	9-07_performancesite.doc	Yes	Yes	Paper Only
Form	21	Personal	9-07_personal.doc	Yes	Yes	Paper Only
Form	22	Personnel Report	9-07_personnelreport.doc	Yes	Yes	Paper Only
Form	23	Resources	9-07_resources.doc	Yes	Yes	Paper Only
Instruction			datatable10.doc	Yes	Yes	Paper Only
Instruction			datatable11.doc	Yes	Yes	Paper Only
Instruction			datatable12a.doc	Yes	Yes	Paper Only
Instruction			datatable12b.doc	Yes	Yes	Paper Only
Instruction			DataTableInstruct.doc	Yes	Yes	Paper Only
Instruction			DataTableIntro.doc	Yes	Yes	Paper Only
Instruction			datatables1-12.doc	Yes	Yes	Paper Only
Instruction			phs398_Rev092007.doc	Yes	Yes	Paper Only
Instruction			SampleTables.doc	Yes	Yes	Paper Only
Instruction			datatable1.doc	Yes	Yes	Paper Only
Form	24	Component	398 component forms.pdf	Yes	Yes	Paper Only
Instruction			datatable3.doc	Yes	Yes	Paper Only
Instruction			datatable4.doc	Yes	Yes	Paper Only
Instruction			datatable5.doc	Yes	Yes	Paper Only
Instruction			datatable6.doc	Yes	Yes	Paper Only
Instruction			datatable7a.doc	Yes	Yes	Paper Only
Instruction			datatable8a.doc	Yes	Yes	Paper Only
Instruction			datatable9a.doc	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55,600

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 66 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55,600	55,600
Annual IC Time Burden (Hours)	2,780,000	2,780,000
Annual IC Cost Burden (Dollars)	227,960	227,960

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.