Information Collection

E Personnel Change Cover Application

IC 226695 under ICR 201906-0915-004 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

Documents and Forms

Document Name Document Type
Form F E Personnel Change Cover Application Form and Instruction
F F_HistoLab_PersonnelChange_Clean_HRSA.doc F_HistoLab_PersonnelChange_Clean_HRSA.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	E Personnel Change Cover Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	F	F_HistoLab_PersonnelChange_Clean_HRSA.doc	F_HistoLab_PersonnelChange_Clean_HRSA.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 395	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	790	790
Annual IC Time Burden (Hours)	3,160	3,160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.