Participant Information Form

Application for Training

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0017 can be found here:

Documents and Forms

Document Name Document Type
Participant Information Form Form
Porposed PIF Form 12_ 8_ 10 OMB Porposed PIF Form 12_ 8_ 10 OMB.docx Form

Information Collection (IC) Details

IC Title:	Participant Information Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	none	Porposed PIF Form 12_ 8_ 10 OMB	Porposed PIF Form 12_ 8_ 10 OMB.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,975	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,975	8,975
Annual IC Time Burden (Hours)	748	748
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.