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Grant Reviewer Recruitment Form
Grant Reviewer Recruitment Form
OMB: 0915-0295
IC ID: 6550
OMB.report
HHS/HSA
OMB 0915-0295
ICR 200802-0915-001
IC 6550
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0295 can be found here:
2023-06-05 - Reinstatement with change of a previously approved collection
2020-02-24 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Grant Reviewer Recruitment Form
Form
FINALInstructionsdocument.doc
Instruction
1 Grant Reviewer Recruitment Form
FEB08FINALform.pdf
Form
FINALPrivacyPolicy.doc
Privacy Policy
IC Document
FINALHRSA Rules P 1.pdf
User Acknowledgement Page 1
IC Document
FINALHRSA Rules P 2.pdf
User Acknowledgement Page 2
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Grant Reviewer Recruitment Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
Grant Reviewer Recruitment Form
FEB08FINALform.pdf
Yes
Yes
Fillable Fileable Signable
Instruction
FINALInstructionsdocument.doc
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,450
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
2,450
0
0
-2,450
0
4,900
Annual IC Time Burden (Hours)
1,735
0
0
-1,015
0
2,750
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Privacy Policy
FINALPrivacyPolicy.doc
02/07/2008
User Acknowledgement Page 1
FINALHRSA Rules P 1.pdf
02/07/2008
User Acknowledgement Page 2
FINALHRSA Rules P 2.pdf
02/07/2008
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.