Information Collection

ANA Consultant and Evaluator Qualifications Form

IC 10119 under ICR 201411-0970-006 · OMB 0970-0265.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0265 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ANA Consultant and Evaluator Qualifications Form	Form and Instruction
1 ANA Panel Reviewer Profile Form ANA Panel Reviewer Profile Form2015(newdraft).pdf	Form and Instruction

IC Title:

ANA Consultant and Evaluator Qualifications Form

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	1	ANA Panel Reviewer Profile Form	ANA Panel Reviewer Profile Form2015(newdraft).pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: ANA Consultant and Evaluator Qualifications Form

FR Citation: 72 FR 37784

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	150	150
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.