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Phs 416-5
PHS Applications and Pre-award Related Reporting (OD)
OMB: 0925-0001
IC ID: 217591
OMB.report
HHS/NIH
OMB 0925-0001
ICR 202408-0925-001
IC 217591
( )
Documents and Forms
Document Name
Document Type
Form 1
PHS 416-5
Form
1 Form
Attachment 12_phs416-5.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PHS 416-5
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
1
Form
Attachment 12_phs416-5.pdf
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:
6,707
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
6,707
0
0
0
0
6,707
Annual IC Time Burden (Hours)
559
0
0
0
0
559
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.
