Information Collection

Applicants

IC 7291 under ICR 201310-0925-004 · OMB 0925-0378.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Applicants	Form and Instruction
1 PRAT NIH 2121-1 Attachment 4 PRAT Application Primary (NIH 2121-1).pdf	Form and Instruction
3 Application Preceptor Selection Verification Attachment 6 PRAT Application Preceptor Selection Verification (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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	PRAT NIH 2121-1	Attachment 4 PRAT Application Primary (NIH 2121-1).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	3	Application Preceptor Selection Verification	Attachment 6 PRAT Application Preceptor Selection Verification (2).pdf		Yes	Yes	Fillable Fileable

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	Change Due to Potential Violation of the PRA
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.