Information Collection

Health Professional Application for Training (HPAT)

IC 217674 under ICR 201902-0920-009 · OMB 0920-1099.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Health Professional Application for Training (HPAT)	Form
Health Professional Application for Training Att 3_HPAT.docx	Form
Health Professional Application for Training - screensho Att 4_HPAT_screenshot.pdf	Form

IC Title:

Agency IC Tracking Number:

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	none	Health Professional Application for Training	Att 3_HPAT.docx		Yes	Yes	Fillable Fileable
Form	none	Health Professional Application for Training - screenshots	Att 4_HPAT_screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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.