Information Collection

Att 3_Health Professional Application for Training (HPAT)

IC 217674 under ICR 201610-0920-011 · OMB 0920-1099.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 3_Health Professional Application for Training (HPAT)	Form
Health Professional Application for Training Att 3 HPAT-wordversion_revised Oct 2016.docx	Form
Health Professional Application for Training Att 3 HPAT-wordversion_approved Feb 2016.docx	Form
Non Substantive Request Justification_10 25 2016.docx Justification for changes	IC Document

IC Title:

Att 3_Health Professional Application for Training (HPAT)

Agency IC Tracking Number:

17BH

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	N/A	Health Professional Application for Training	Att 3 HPAT-wordversion_revised Oct 2016.docx		Yes	Yes	Fillable Fileable
Form	N/A	Health Professional Application for Training	Att 3 HPAT-wordversion_approved Feb 2016.docx		Yes	Yes	Fillable Fileable

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 %

table that charts list of burden
	Approved	Previously Approved
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

table that charts IC Documents
Title	Document	Date Uploaded
Justification for changes	Non Substantive Request Justification_10 25 2016.docx	10/25/2016

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