Information Collection

Phs-50

IC 7733 under ICR 201007-0937-001 · OMB 0937-0025.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0937-0025 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	PHS-50	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 21.28 42 CFR 21.34 42 CFR 21.22 42 CFR 21.58

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: PHS Commissioned Corps General Personnel Records	FR Citation: 63 FR 68596

Number of Respondents: 2,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,500	1,500	1,000
Annual IC Time Burden (Hours)	2,500	1,500	1,000
Annual IC Cost Burden (Dollars)	30,000	28,000	2,000

Documents for IC

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