Information Collection

Attachment 4 Former PS-OC Trainee Survey

IC 215697 under ICR 201503-0925-005 · OMB 0925-0727.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Attachment 4 Former PS-OC Trainee Survey	Form and Instruction
2 Former PS-OC Trainee Survey Attach4_FormerTrainee Survey_PS-OC_6-17-2015.docx	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	2	Former PS-OC Trainee Survey	Attach4_FormerTrainee Survey_PS-OC_6-17-2015.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 340

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	340	340
Annual IC Time Burden (Hours)	142	142
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.