Information Collection

Attachment 2 - Survey of Applicants

IC 209807 under ICR 201312-0925-007 · OMB 0925-0690.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0690 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Attachment 2 - Survey of Applicants	Form and Instruction
2 SURVEY OF APPLICANTS Attach 2B.Survey of Applicants (Word Document).11-5-13.docx	Form and Instruction
Attach 2A.Survey of Applicants (Screenshots).11-5-13.docx Attach 2A	IC Document

IC Title:

Attachment 2 - Survey of Applicants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	SURVEY OF APPLICANTS	Attach 2B.Survey of Applicants (Word Document).11-5-13.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD

FR Citation: 67 FR 60743

Number of Respondents: 170

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	170	170
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach 2A	Attach 2A.Survey of Applicants (Screenshots).11-5-13.docx	11/13/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.