Information Collection

Att 3_Health Professional Application for Training (HPAT)

IC 217674 under ICR 201611-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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-Oct 2016 final with new Nov edits.docx	Form
Health Application for Training Att 3 HPAT-wordversion-Proposed Final Nov 2016.docx	Form

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-Oct 2016 final with new Nov edits.docx		Yes	Yes	Fillable Fileable
Form	N/A	Health Application for Training	Att 3 HPAT-wordversion-Proposed Final Nov 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
No associated records found

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