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PHS Assignment Request Form
PHS Applications and Pre-award Related Reporting (OD)
OMB: 0925-0001
IC ID: 217564
OMB.report
HHS/NIH
OMB 0925-0001
ICR 201507-0925-007
IC 217564
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:
2022-10-05 - Revision of a currently approved collection
2022-07-22 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Attachment 5B PHS Assignment Request Instructions.docx
Instruction
Attachment 5A PHS 398 and SF 424 (R&R) Forms.docx
Instruction
1 Attachment 5C PHS Assignment Request Form
Attachment 5C PHS Assignment Request Form.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PHS Assignment Request Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
Attachment 5A PHS 398 and SF 424 (R&R) Forms.docx
Yes
Yes
Printable Only
Form
1
Attachment 5C PHS Assignment Request Form
Attachment 5C PHS Assignment Request Form.docx
Yes
Yes
Fillable Fileable
Instruction
Attachment 5B PHS Assignment Request Instructions.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,354
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
3,354
0
3,354
0
0
0
Annual IC Time Burden (Hours)
1,677
0
1,677
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.