Information Collection

398 Forms and Instructions (Paper)

IC 37814 under ICR 201206-0925-007 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3A 398 Forms and Instructions (Paper)	Form
Attachment 4A PHS 398 Paper Application Instructions.doc	Instruction
Attachment 4B PHS 398 NRSA Data Table Format Instructions.docx	Instruction
Attachment 11 Supplemental Instructions for PHS 398 and PHS 416 Applications.doc	Instruction
3A PHS 398 Paper Application Forms Attachment 3A PHS 398 Paper Application Forms.doc	Form
3B PHS 398 Attachment 3B PHS 398 NRSA Data Table Format.docx	Form

IC Title:

398 Forms and Instructions (Paper)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3A	PHS 398 Paper Application Forms	Attachment 3A PHS 398 Paper Application Forms.doc	Yes	Yes	Paper Only
Form	3B	PHS 398	Attachment 3B PHS 398 NRSA Data Table Format.docx	Yes	Yes	Paper Only
Instruction			Attachment 4A PHS 398 Paper Application Instructions.doc	Yes	Yes	Paper Only
Instruction			Attachment 4B PHS 398 NRSA Data Table Format Instructions.docx	Yes	Yes	Paper Only
Instruction			Attachment 11 Supplemental Instructions for PHS 398 and PHS 416 Applications.doc	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,389

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,389	-3,426	11,815
Annual IC Time Burden (Hours)	293,615	-119,910	413,525
Annual IC Cost Burden (Dollars)	0	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.