NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)

[NCHHSTP] National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC)

Documents and Forms

Document Name Document Type
Form 0920-25-0110 NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT) Form
Form 0920-25-0110 NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT) Form
0920-25-0110 Att 3_Approved NNPTC HPAT_clean Att 3_Approved NNPTC HPAT_clean.docx Form
0920-25-0110 Att 3_Approved NNPTC HPAT_clean Att 3_Approved NNPTC HPAT_clean.docx Form
Change Request Memo.docx Change Request Memo IC Document
Change Request Memo.docx Change Request Memo IC Document

Information Collection (IC) Details

IC Title:	NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	Agency IC Tracking Number:	0920-25-0110

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-25-0110	Att 3_Approved NNPTC HPAT_clean	Att 3_Approved NNPTC HPAT_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-20-0161 "Records of Health Professionals in Disease Prevention and Control Training Programs"	FR Citation: 51 FR 42485

Number of Respondents: 4,500	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Change Request Memo	Change Request Memo.docx	05/01/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.