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AENT Program Forms
The Advanced Nursing Education Workforce (ANEW) Program Specific Data Collection Forms
OMB: 0915-0375
IC ID: 209293
OMB.report
HHS/HSA
OMB 0915-0375
ICR 202004-0915-003
IC 209293
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0375 can be found here:
2024-03-07 - Revision of a currently approved collection
2021-11-16 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
AENT Program Forms
Form and Instruction
1 ANEW Form - Table 1 .docx
ANEW Form - Table 1 .docx
Form and Instruction
2 ANEW Form - Table 2 .docx
ANEW Form - Table 2 .docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
AENT Program Forms
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
ANEW Form - Table 1 .docx
ANEW Form - Table 1 .docx
Yes
Yes
Fillable Fileable
Form and Instruction
2
ANEW Form - Table 2 .docx
ANEW Form - Table 2 .docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
236
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
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
236
0
0
0
0
236
Annual IC Time Burden (Hours)
1,652
0
0
0
0
1,652
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.