Att 3_Health Professional Application for Training (HPAT)

Capacity Building Assistance Program: Assessment and Quality Control

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1099 can be found here:

Documents and Forms

Document Name Document Type
Att 3 HPAT-wordversion.docx Other-WORD
Att 4 HPAT-screenshot.pdf Other-SCREENSHOTS

Information Collection (IC) Details

IC Title:	Att 3_Health Professional Application for Training (HPAT)	Agency IC Tracking Number:	16NR

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
Other-WORD			Att 3 HPAT-wordversion.docx		Yes	Yes	Fillable Printable
Other-SCREENSHOTS			Att 4 HPAT-screenshot.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,400	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,800	14,800
Annual IC Time Burden (Hours)	1,233	1,233
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.