Information Collection

PHS 398 Cover Page Supplement

IC 202963 under ICR 202408-0925-001 · OMB 0925-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 PHS 398 Cover Page Supplement	Form
1 Application Attachment 5D_PHS 398 Cover Page Supplement Form_Instructions_FORMS-I.docx	Form
1 Application Attachment 5D_PHS 398 Cover Page Supplement Form_Instructions_FORMS-I.docx	Form
2 Application Attachment 5E_PHS398_CoverPageSupplement_5_0-V5.0_FORMS-I.pdf	Form
2 Application Attachment 5E_PHS398_CoverPageSupplement_5_0-V5.0_FORMS-I.pdf	Form

IC Title:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Application	Attachment 5D_PHS 398 Cover Page Supplement Form_Instructions_FORMS-I.docx		Yes	Yes	Fillable Fileable
Form	2	Application	Attachment 5E_PHS398_CoverPageSupplement_5_0-V5.0_FORMS-I.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 74,239

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	74,239	74,239
Annual IC Time Burden (Hours)	74,239	74,239
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.