ODPHP/PCSFN Speaker Request Form

Prevention Communication Formative Research

Documents and Forms

Document Name Document Type
Form 1 ODPHP/PCSFN Speaker Request Form Form and Instruction
1 ODPHP Speakers Bureau Application ODPHP Speakers Bureau Application_1.13.22.docx Form and Instruction
ODPHP/PCSFN Speaki ODPHP/PCSFN Speaking Request Form ODPHP_PCSFN Speaking Request Form _ health.pdf Form and Instruction
ODPHP Speakers Bureau Application_3.31.docx Speakers Bureau Supplementary Document IC Document

Information Collection (IC) Details

IC Title:	ODPHP/PCSFN Speaker Request Form	Agency IC Tracking Number:

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	1	ODPHP Speakers Bureau Application	ODPHP Speakers Bureau Application_1.13.22.docx		Yes	Yes	Fillable Fileable
Form and Instruction	ODPHP/PCSFN Speaking Request Form	ODPHP/PCSFN Speaking Request Form	ODPHP_PCSFN Speaking Request Form _ health.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Speakers Bureau Supplementary Document	ODPHP Speakers Bureau Application_3.31.docx	04/04/2022

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