Information Collection

AENT Program Forms

IC 209293 under ICR 201311-0915-002 · OMB 0915-0375.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0375 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1A AENT Program Forms	Form and Instruction
1A Rural Underserved or PH practice settings; Graduate data Table 1A Rural Underserved or PH Practice Settings Graduates .docx 4 dec 13.docx	Form and Instruction
1B Rural Underserve or PH settings graduates supported with Table 1B Rural Underserved or PHealth Practice Settings Graduates Supported .docx 4 dec 13.docx	Form and Instruction
2A 2a projected master degree and post nursing master stude Table 2 A Projected Masters Degree and Post Nursing Masters .docx 4 dec 13.docx	Form and Instruction
2B 2b projected doctoral degree students with instructions Table 2B Projected Doctoral Degree Students with Instructions.docx 4 dec 13.docx	Form and Instruction

IC Title:

AENT Program Forms

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1A	Rural Underserved or PH practice settings; Graduate data with instructions	Table 1A Rural Underserved or PH Practice Settings Graduates .docx 4 dec 13.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1B	Rural Underserve or PH settings graduates supported with instructions	Table 1B Rural Underserved or PHealth Practice Settings Graduates Supported .docx 4 dec 13.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2A	2a projected master degree and post nursing master students with instructions	Table 2 A Projected Masters Degree and Post Nursing Masters .docx 4 dec 13.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2B	2b projected doctoral degree students with instructions	Table 2B Projected Doctoral Degree Students with Instructions.docx 4 dec 13.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	882	882
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.