Information Collection

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

IC 4196 under ICR 201006-0648-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
NOAA'sTeacher at Sea Form A: Participant's Application 0283 forma.pdf	Form
NOAA Health Services Questionnaire 0283 NHSQ.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	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 %

table that charts list of burden
	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

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.