Information Collection

Attachment 2 - Survey of Applicants

IC 209807 under ICR 201403-0925-005 · OMB 0925-0690.

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
2 SURVEY OF APPLICANTS Revised Attach B_Survey Applicants_REV-2-25-2014.docx	Form and Instruction

IC Title:

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	SURVEY OF APPLICANTS Revised	Attach B_Survey Applicants_REV-2-25-2014.docx		Yes	Yes	Fillable Fileable
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	Previously Approved
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
No associated records found

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