Information Collection

NHSC Ambassador Portal

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NHSC Ambassador Portal	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.