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

NOAA Teacher-At-Sea Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
NOAA Teacher-At-Sea Program Participant Application and Health Services Questionnaire Form
NOAA'sTeacher at Sea Form A: Participant's Application 0283 forma.pdf Form
NOAA Health Services Questionnaire 0283 NHSQ.pdf Form and Instruction

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	NOAA'sTeacher at Sea Form A: Participant's Application	0283 forma.pdf		Yes	No	Fillable Printable
Form and Instruction	NA	NOAA Health Services Questionnaire	0283 NHSQ.pdf		Yes	Yes	Fillable Fileable

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: 75 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	125	0	125
Annual IC Time Burden (Hours)	156	0	156
Annual IC Cost Burden (Dollars)	63	-217	280

Documents for IC

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.