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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.