Addendum: Commissioned Corps Personal Statement

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⚠️ Notice: This information collection may be referencing outdated material.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
0937-0025 PHS_PersonalStatement_12-22-16.docx Other-personal statement

Information Collection (IC) Details

IC Title:	Addendum: Commissioned Corps Personal Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-personal statement			0937-0025 PHS_PersonalStatement_12-22-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,500	500	3,000
Annual IC Time Burden (Hours)	875	125	750
Annual IC Cost Burden (Dollars)	0	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.