Information Collection

Fellowship Program Application

IC 215147 under ICR 201502-0925-004 · OMB 0925-0716.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0716 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Fellowship Program Application Form and Instruction
1 Attachment 1 Fellowship Program App A1 Fellowship Program App.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Fellowship Program Application	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	1	Attachment 1 Fellowship Program App	A1 Fellowship Program App.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	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	150	150
Annual IC Time Burden (Hours)	75	75
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.