Information Collection

Referees

IC 182094 under ICR 201008-0925-002 · OMB 0925-0378.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0378 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Referees Form and Instruction
1 form ATTACHMENT 7_PRAT Preceptor Selection Verification Form.pdf Form and Instruction
2 form ATTACHMENT 4_PRAT Primary Application_NIH Form2721-1.pdf Form and Instruction
3 form ATTACHMENT 5_PRAT Request for Evaluation_NIH Form2721-2.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Referees	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	form	ATTACHMENT 7_PRAT Preceptor Selection Verification Form.pdf	No	No	Paper Only
Form and Instruction	2	form	ATTACHMENT 4_PRAT Primary Application_NIH Form2721-1.pdf	Yes	Yes	Paper Only
Form and Instruction	3	form	ATTACHMENT 5_PRAT Request for Evaluation_NIH Form2721-2.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	131	131
Annual IC Cost Burden (Dollars)	0	0

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.