Information Collection

Phs-1813

IC 46578 under ICR 202312-0937-001 · OMB 0937-0025.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PHS-1813 PHS-1813	Form
PHS-1813 REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH S PHS 1813 Update 2023 (1).pdf	Form
PHS-1813 REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH S PHS 1813 Update 2023 (1).pdf	Form

IC Title:

PHS-1813

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 21.28 42 CFR 21.34 42 CFR 21.22 42 CFR 21.58

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	PHS-1813	REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH SERVICE COMMISSIONED CORPS	PHS 1813 Update 2023 (1).pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: PHS Commissioned Corps General Personnel Records

FR Citation: 63 FR 68596

Number of Respondents: 3,500

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	Previously Approved
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	875	875
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.