PHS Assignment Request Form

PHS Applications and Pre-award Related Reporting (OD)

OMB: 0925-0001

IC ID: 217564

Information Collection (IC) Details

View Information Collection (IC)

PHS Assignment Request Form
 
No Removed
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 14 PHS Assignment Request Form Attachment 5C PHS Assignment Request Form_FORMS-F.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

3,354 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 -3,354 0 0 3,354
Annual IC Time Burden (Hours) 0 0 -1,677 0 0 1,677
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PHS Assignment Request Instructions Attachment 5B_PHS Assignment Request Form_Instructions_FORMS-F.pdf 12/27/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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