Information Collection

NIH/NHMA Fellows Program Application

IC 222876 under ICR 201608-0925-001 · OMB 0925-0748.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0748 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 11 NHMA Application Form NIH/NHMA Fellows Program Application	Form and Instruction
11 NHMA Application Form (11) NHMA Application_Final.pdf	Form and Instruction

IC Title:

NIH/NHMA Fellows Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	11				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Clinical Research: Student Records, HHS/NIH/OD/OIR/OE

FR Citation: 67 FR 60776

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	67	67
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.

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