Attachment 2 - Survey of Applicants

Outcomes Evaluation of the National Cancer Institute (NCI) Cancer Prevention Fellowship Program (CPFP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0690 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Attachment 2 - Survey of Applicants Form and Instruction
2 SURVEY OF APPLICANTS Attach 2B.Survey of Applicants (Word Document).11-5-13.docx Form and Instruction
Attach 2A.Survey of Applicants (Screenshots).11-5-13.docx Attach 2A IC Document

Information Collection (IC) Details

IC Title:	Attachment 2 - Survey of Applicants	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	2	SURVEY OF APPLICANTS	Attach 2B.Survey of Applicants (Word Document).11-5-13.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD	FR Citation: 67 FR 60743

Number of Respondents: 170	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	170	170
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attach 2A	Attach 2A.Survey of Applicants (Screenshots).11-5-13.docx	11/13/2013

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