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Phs-1813
Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps
OMB: 0937-0025
IC ID: 46578
OMB.report
HHS/OASH
OMB 0937-0025
ICR 202312-0937-001
IC 46578
( )
Documents and Forms
Document Name
Document Type
Form PHS-1813
PHS-1813
Form
PHS-1813 REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH S
PHS 1813 Update 2023 (1).pdf
Form
PHS-1813 REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH S
PHS 1813 Update 2023 (1).pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PHS-1813
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
42 CFR 21.28
42 CFR 21.34
42 CFR 21.22
42 CFR 21.58
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
PHS-1813
REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH SERVICE COMMISSIONED CORPS
PHS 1813 Update 2023 (1).pdf
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
PHS Commissioned Corps General Personnel Records
FR Citation:
63 FR 68596
Number of Respondents:
3,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
3,500
0
0
0
0
3,500
Annual IC Time Burden (Hours)
875
0
0
0
0
875
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.