Att 3_Health Professional Application for Training (HPAT)

Capacity Building Assistance Program: Assessment and Quality Control

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.