Information Collection

Referees

IC 182094 under ICR 201310-0925-004 · OMB 0925-0378.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 PRAT Preceptor Selection Verification Referees	Form and Instruction
Form 2 PRAT 2721-2 Referees	Form and Instruction
2 PRAT 2721-2 Attachment 5 PRAT NIH 2721-2 Application Evaluation Request.pdf	Form and Instruction
3 PRAT Preceptor Selection Verification Attachment 6 PRAT Application Preceptor Selection Verification (2).pdf	Form and Instruction

IC Title:

Referees

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2				Yes	Yes	Fillable Fileable
Form and Instruction	3				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
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

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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