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NAT Forms
Nurse Anesthetist Traineeship (NAT) Program
OMB: 0915-0374
IC ID: 209481
OMB.report
HHS/HSA
OMB 0915-0374
ICR 201311-0915-005
IC 209481
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0374 can be found here:
2019-10-29 - Revision of a currently approved collection
2017-01-13 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
NAT Forms
Form and Instruction
1 Table 1
Table 1 NAT forms.docx
Form and Instruction
2A Table 2A
Table 2A NAT Forms.docx
Form and Instruction
2B Table 2B
Table 2B NAT forms.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
NAT Forms
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
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
1
Table 1
Table 1 NAT forms.docx
Yes
Yes
Fillable Fileable
Form and Instruction
2A
Table 2A
Table 2A NAT Forms.docx
Yes
Yes
Fillable Fileable
Form and Instruction
2B
Table 2B
Table 2B NAT forms.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
100
0
100
0
0
0
Annual IC Time Burden (Hours)
774
0
774
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.