Information Collection

NYCALC Student Medical Information (Form 3-2525)

IC 242613 under ICR 202109-1018-004 · OMB 1018-0176.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1018-0176 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3-2525 NYCALC Student Medical Information (Form 3-2525)	Form
3-2525 Native Youth Community Adaptation and Leadership Congres Form 3-2525 NYCALC Student Medical Information Form w-PRA.docx www.nycalc.org	Form
3-2525 Native Youth Community Adaptation and Leadership Congres Form 3-2525 NYCALC Student Medical Information Form w-PRA.docx www.nycalc.org	Form

IC Title:

NYCALC Student Medical Information (Form 3-2525)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	3-2525	Native Youth Community Adaptation and Leadership Congress - Student Medical Information	Form 3-2525 NYCALC Student Medical Information Form w-PRA.docx	https://www.nycalc.org	Yes	Yes	Fillable Fileable Signable

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records

Title: DOI-16, DOI Learn (Department-wide Learning Management System)

FR Citation: 83 FR 50682

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.