Referees

Application for the Pharmacology Research Associate Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0378 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Referees Form and Instruction
1 Application for Pharmacology Research Associate Program Application_part1_fillable.revised.pdf Form and Instruction
2 Preceptor Selection Verification Form Application_part2.pdf Form and Instruction
3 Pharmacology Research Associate Program Request for Eval Application_part3.pdf Form and Instruction
Introductory Letter.doc Introductory Letter IC Document

Information Collection (IC) Details

IC Title:	Referees	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Application for Pharmacology Research Associate Program	Application_part1_fillable.revised.pdf	Yes	Yes	Paper Only
Form and Instruction	2	Preceptor Selection Verification Form	Application_part2.pdf	Yes	Yes	Paper Only
Form and Instruction	3	Pharmacology Research Associate Program Request for Evaluation of Applicant	Application_part3.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	131	131
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Introductory Letter	Introductory Letter.doc	09/18/2007

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