Information Collection

Providers Trainees - State/Tribal

IC 178433 under ICR 201512-0930-006 · OMB 0930-0286.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Document Name Document Type
Form Provider Trainee I Providers Trainees - State/Tribal Form and Instruction
Provider Trainee I Provider Trainee Instruments AttachmentsE-1_E-5.pdf Form and Instruction
Att E-6. TUP-S Consent to Contact (RCT) StateTribal Dec2015.docx TUP-S Consent to Contact (RCT) StateTribal IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Providers Trainees - State/Tribal	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Provider Trainee Instruments	Provider Trainee Instruments	AttachmentsE-1_E-5.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,376	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	Previously Approved
Annual Number of Responses for this IC	10,376	6,909	3,467
Annual IC Time Burden (Hours)	3,027	2,632	395
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
TUP-S Consent to Contact (RCT) StateTribal	Att E-6. TUP-S Consent to Contact (RCT) StateTribal Dec2015.docx	12/23/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.