Information Collection

ODPHP/PCSFN Speaker Request Form

IC 251778 under ICR 202109-0990-009 · OMB 0990-0281.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0281 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ODPHP Speakers Bureau Application ODPHP/PCSFN Speaker Request Form	Form and Instruction
Form ODPHP/PCSFN Speaki ODPHP/PCSFN Speaking Request Form ODPHP/PCSFN Speaker Request Form	Form and Instruction
1 ODPHP Speakers Bureau Application ODPHP Speakers Bureau Application_1.13.22.docx	Form and Instruction
ODPHP/PCSFN Speaki ODPHP/PCSFN Speaking Request Form ODPHP_PCSFN Speaking Request Form _ health.pdf	Form and Instruction
ODPHP Speakers Bureau Application_3.31.docx Speakers Bureau Supplementary Document	IC Document

IC Title:

ODPHP/PCSFN Speaker Request Form

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1				Yes	Yes	Fillable Fileable
Form and Instruction	ODPHP/PCSFN Speaking Request Form				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Speakers Bureau Supplementary Document		04/04/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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