Information Collection

Providers Trainees

IC 178433 under ICR 202311-0930-002 · OMB 0930-0286.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TSA Consent to Con Providers Trainees	Form and Instruction
TSA Consent to Con TSA Consent to Contact Att F. TSA-Phone for OMB 7_24_23 final.docx	Form and Instruction
TSA Consent to Con TSA Consent to Contact Att F. TSA-Phone for OMB 7_24_23 final.docx	Form and Instruction
TSA-P TSA-P Att D. TSA-Post_for OMB 7_24_23 final.docx	Form and Instruction
TSA-P TSA-P Att D. TSA-Post_for OMB 7_24_23 final.docx	Form and Instruction
TSA-6-12 TSA-6-12 Att E. TSA-6_12_for OMB 7_24_23 final.docx	Form and Instruction
TSA-6-12 TSA-6-12 Att E. TSA-6_12_for OMB 7_24_23 final.docx	Form and Instruction

IC Title:

Providers Trainees

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	TSA Consent to Contact	TSA Consent to Contact	Att F. TSA-Phone for OMB 7_24_23 final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	TSA-P	TSA-P	Att D. TSA-Post_for OMB 7_24_23 final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	TSA-6-12	TSA-6-12	Att E. TSA-6_12_for OMB 7_24_23 final.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,428

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	20,428	20,428
Annual IC Time Burden (Hours)	3,974	3,974
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.