Information Collection

Attachment J_PSO Voluntary Relinquishment Form

IC 231738 under ICR 202512-0935-001 · OMB 0935-0143.

Documents and Forms

Document Name Document Type
Form Form 7 Attachment J_PSO Voluntary Relinquishment Form Form and Instruction
Form Form 7 PSO Request for Voluntary Relinquishment Attachment J_PSO Voluntary Relinquishment Form Form and Instruction
Form 7 PSO Request for Voluntary Relinquishment Attachment J_DRAFT_PSO Voluntary Relinquishment.docx Form and Instruction
Form 7 PSO Request for Voluntary Relinquishment Attachment J_DRAFT_PSO Voluntary Relinquishment.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment J_PSO Voluntary Relinquishment Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 and Instruction	Form 7	PSO Request for Voluntary Relinquishment	Attachment J_DRAFT_PSO Voluntary Relinquishment.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

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.

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