Information Collection

PHS Fellowship Supplemental Form (electronic)

IC 202959 under ICR 201206-0925-007 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Document Name Document Type
Form 6A PHS Fellowship Supplemental Form (electronic) Form and Instruction
6A PHS 398 Fellowship Supplemental Form Attachment 6A PHS 398 Fellowship Supplemental Form Instructions.doc Form and Instruction
6B Fellowship Supplemental Form Attachment 6B PHS 398 Fellowship Supplemental Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PHS Fellowship Supplemental Form (electronic)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	6A	PHS 398 Fellowship Supplemental Form	Attachment 6A PHS 398 Fellowship Supplemental Form Instructions.doc		Yes	Yes	Fillable Fileable
Form and Instruction	6B	Fellowship Supplemental Form	Attachment 6B PHS 398 Fellowship Supplemental Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,915	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	4,915	4,915
Annual IC Time Burden (Hours)	78,640	78,640
Annual IC Cost Burden (Dollars)	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.