Information Collection

Trainee Survey

IC 260417 under ICR 202305-0915-006 · OMB 0915-0392.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0392 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Trainee Survey	Form
4 Trainee Survey Attachment5_RPHWTNPTraineeSurvey.pdf	Form
4 Trainee Survey Attachment5_RPHWTNPTraineeSurvey_revised.pdf	Form
4R Trainee Survey_Redline Attachment5_RPHWTNPTraineeSurvey_edits.docx	Form

IC Title:

Trainee Survey

Agency IC Tracking Number:

Is this a Common Form? No

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	4	Trainee Survey	Attachment5_RPHWTNPTraineeSurvey_revised.pdf		Yes	Yes	Fillable Fileable
Form	4R	Trainee Survey_Redline	Attachment5_RPHWTNPTraineeSurvey_edits.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	250	250
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.