Information Collection

NHSC Ambassador Portal

IC 211727 under ICR 201405-0915-004 · OMB 0915-0388.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NHSC Ambassador Portal	Form and Instruction
1 NHSC Ambassador Portal DEA_Ambassador Database_ Application User Guide_ December 2013.pdf programportal.hrsa.gov/extranet/ambassador/login.seam	Form and Instruction

IC Title:

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	1	NHSC Ambassador Portal	DEA_Ambassador Database_ Application User Guide_ December 2013.pdf	https://programportal.hrsa.gov/extranet/ambassador/login.seam	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

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	700	700
Annual IC Time Burden (Hours)	70	70
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.