Information Collection

Participant Information Form (PIF)

IC 221598 under ICR 201605-0915-002 · OMB 0915-0281.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0281 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Participant Information Form (PIF)	Form
2 HRSA AETC PIF 2016 HRSA AETC_PIF_2016.doc	Form

IC Title:

Participant Information Form (PIF)

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2	HRSA AETC PIF 2016	HRSA AETC_PIF_2016.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 114,423

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	114,423	114,423
Annual IC Time Burden (Hours)	8,010	8,010
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.