Phs-50

Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps

Documents and Forms

Document Name Document Type
Form PHS-50 PHS-50 Form and Instruction
PHS-50 APPLICATION FOR APPOINTMENT AS A COMMISSIONED OFFICER IN PHS-50 Update 2023.pdf Form and Instruction
PHS-50 APPLICATION FOR APPOINTMENT AS A COMMISSIONED OFFICER IN PHS-50 Update 2023.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	PHS-50	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 21.58 42 CFR 21.28 42 CFR 21.22 42 CFR 21.34

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PHS-50	APPLICATION FOR APPOINTMENT AS A COMMISSIONED OFFICER IN THE COMMISSIONED CORPS OF THE U.S. PUBLIC HEALTH SERVICE	PHS-50 Update 2023.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 %

	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)	42,000	42,000

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.