Phs-50

Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0937-0025 can be found here:

Documents and Forms

Document Name Document Type
PHS-50_11-18-19.pdf Other-Form

Information Collection (IC) Details

IC Title:	PHS-50	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 21.34 42 CFR 21.28 42 CFR 21.22 42 CFR 21.58

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Form			PHS-50_11-18-19.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: PHS Commissioned Corps General Personnel Records	FR Citation: 63 FR 68596

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,000	2,000	1,000
Annual IC Time Burden (Hours)	750	-250	1,000
Annual IC Cost Burden (Dollars)	36,000	24,000	12,000

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.