Information Collection

PHS 398 Paper

IC 37814 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 Paper	Form
1 Application Attachment 3 PHS 398_forms_FORMS-I.pdf	Form
1 Application Attachment 3 PHS 398_forms_FORMS-I.pdf	Form
2 Application Attachment 4 phs398 instructions_FORMS-I.docx	Form
2 Application Attachment 4 phs398 instructions_FORMS-I.docx	Form

IC Title:

PHS 398 Paper

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 3 PHS 398_forms_FORMS-I.pdf		Yes	No	Paper Only
Form	2	Application	Attachment 4 phs398 instructions_FORMS-I.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,247

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	4,247	4,247
Annual IC Time Burden (Hours)	148,645	148,645
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.