Information Collection

416-1

IC 186003 under ICR 201102-0925-008 · OMB 0925-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13 416-1	Form
8 form 416-1fp4.doc	Form and Instruction
2 form 416-1applicant-fellowbiosketchsample.docm	Form and Instruction
3 form 416-1checklist.doc	Form
4 form 416-1cont.docm	Form and Instruction
5 form 416-1fp1.docm	Form and Instruction
6 form 416-1fp2.docm	Form and Instruction
19 form SF424 RR Fellowship 5.3 Supplemental Form Instructions Final.doc	Form and Instruction
7 form 416-1fp3.doc	Form and Instruction
9 form 416-1fp5.docm	Form and Instruction
10 form 416-1-Inclusion enrollment_report.docm	Form and Instruction
11 form 416-1personal.docm	Form and Instruction
1 form 416-1 fellowship applicant biosketch.doc	Form and Instruction
14 form 416-1sponsorbiosketchsample.docm	Form and Instruction
15 form 416-1-Targeted_Planned enrollment_table.docm	Form and Instruction
16 form 416- optional additional performance sites.docm	Form and Instruction
18 form Fellowship Supplemental Form Mock-Up 2009.pdf	Form
17 416-1 phs416-1 2009.doc	Form and Instruction
13 form 416-1sponsorbiosketch.doc	Form

IC Title:

416-1

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	13	form	416-1sponsorbiosketch.doc	Yes	Yes	Paper Only
Form and Instruction	8	form	416-1fp4.doc	Yes	Yes	Paper Only
Form and Instruction	2	form	416-1applicant-fellowbiosketchsample.docm	Yes	Yes	Paper Only
Form	3	form	416-1checklist.doc	Yes	Yes	Paper Only
Form and Instruction	4	form	416-1cont.docm	Yes	Yes	Paper Only
Form and Instruction	5	form	416-1fp1.docm	Yes	Yes	Paper Only
Form and Instruction	6	form	416-1fp2.docm	Yes	Yes	Paper Only
Form and Instruction	19	form	SF424 RR Fellowship 5.3 Supplemental Form Instructions Final.doc	Yes	Yes	Paper Only
Form and Instruction	7	form	416-1fp3.doc	Yes	Yes	Paper Only
Form and Instruction	10	form	416-1-Inclusion enrollment_report.docm	Yes	Yes	Paper Only
Form and Instruction	11	form	416-1personal.docm	Yes	Yes	Paper Only
Form and Instruction	1	form	416-1 fellowship applicant biosketch.doc	Yes	Yes	Paper Only
Form and Instruction	14	form	416-1sponsorbiosketchsample.docm	Yes	Yes	Paper Only
Form and Instruction	15	form	416-1-Targeted_Planned enrollment_table.docm	Yes	Yes	Paper Only
Form and Instruction	16	form	416- optional additional performance sites.docm	Yes	Yes	Paper Only
Form	18	form	Fellowship Supplemental Form Mock-Up 2009.pdf	Yes	Yes	Paper Only
Form and Instruction	17	416-1	phs416-1 2009.doc	Yes	Yes	Paper Only
Form and Instruction	9	form	416-1fp5.docm	No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,900

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,900	4,900
Annual IC Time Burden (Hours)	88,200	88,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.