Information Collection

Application For Staff Fellowship Program

IC 111176 under ICR 197712-0925-002 · OMB 0925-0005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0005 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	APPLICATION FOR STAFF FELLOWSHIP PROGRAM	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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	PHS-3997				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,500	1,205	295
Annual IC Time Burden (Hours)	1,500	1,205	295
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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