Phs-1813

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⚠️ Notice: This information collection may be referencing outdated material.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-1813 Commissioned Corps Reference Form_12-14-16.pdf Other-Reference Form

Information Collection (IC) Details

IC Title:	PHS-1813	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 21.28 42 CFR 21.34 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-Reference Form			PHS-1813 Commissioned Corps Reference Form_12-14-16.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: 3,500	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	3,500	-500	4,000
Annual IC Time Burden (Hours)	875	-125	1,000
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.