Information Collection

Applicants

IC 7291 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1 Verification Form Applicants	Form and Instruction
Form 2 Associate Program Applicants	Form and Instruction
Form 3 Evaluation Form Applicants	Form and Instruction
1 Verification Form ATTACHMENT 7_PRAT Preceptor Selection Verification Form.pdf	Form and Instruction
2 Associate Program ATTACHMENT 4_PRAT Primary Application_NIH Form2721-1.pdf	Form and Instruction
3 Evaluation Form ATTACHMENT 5_PRAT Request for Evaluation_NIH Form2721-2.pdf	Form and Instruction

IC Title:

Applicants

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Paper Only
Form and Instruction	2	Yes	Yes	Paper Only
Form and Instruction	3	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

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.

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