LRP Ambassador Sign-up and Consent

Conference, Meeting, Workshop, and Poster Session Registration Generic Clearance (OD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Document Name Document Type
Form 1 LRP Ambassador Sign-up and Consent Form
1 LRP Ambassador Sign-up Form LRP Ambassador Sign-up Form 7-28-16.docx Form
LRP Ambassador OMB Clearance Form 7-28-16.doc LRP Ambassador OMB Clearance Form IC Document

Information Collection (IC) Details

IC Title:	LRP Ambassador Sign-up and Consent	Agency IC Tracking Number:

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
Form	1	LRP Ambassador Sign-up Form	LRP Ambassador Sign-up Form 7-28-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: National Institutes of Health (NIH) Office of Loan Repayment and Scholarship (OLRS) Record System, HHS/NIH/OD.	FR Citation: 67 FR 6043

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
LRP Ambassador OMB Clearance Form	LRP Ambassador OMB Clearance Form 7-28-16.doc	07/28/2016

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