PHS Applications and Pre-award Related Reporting (OD)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 PHS 398 Paper Application	Form	Unchanged	Available
Form 1 PHS 398 Paper Application	Form and Instruction	Unchanged	Available
Form 1 Individual Fellowship Activation Notice	Form and Instruction	Unchanged	Available
Form 2 STTR Funding Agreement Certification	Form and Instruction	Unchanged	Available
Form 1 SBIR Funding Agreement Certification	Form and Instruction	Unchanged	Available
Form 1 VCOC Certification	Form and Instruction	Unchanged	Available
Form 1 PHS 6031	Form and Instruction	Unchanged	Available
Form 6 Attachment 7G PHS 416-1 Continuation Page	Form and Instruction	Unchanged	Available
Form 5 Attachment 7F PHS 416-1 Checklist Form Page	Form and Instruction	Unchanged	Repair queued
Form 4 Attachment 7E PHS 416-1 Face Page 4	Form and Instruction	Unchanged	Repair queued
Form 3 Attachment 7D PHS 416-1 Face Page 3	Form and Instruction	Unchanged	Available
Form 2 Attachment 7C PHS 416-1 Face Page 2	Form and Instruction	Unchanged	Available
Form 1 Attachment 7B PHS 416-1 Face Page 1	Form and Instruction	Unchanged	Available
Form 1 Fellowship Applicant Biographical Format Page	Form and Instruction	Unchanged	Available
Form 1 Attachment 5G PHS Inclusion Enrollment Report	Form and Instruction	Unchanged	Available
Form 1 Attachment 5C PHS Assignment Request Form	Form	Unchanged	Available
Form 1 Fellowship Supplemental Form	Form and Instruction	Unchanged	Available
Form 1 General Biographical Sketch Format Page	Form and Instruction	Unchanged	Available
Form 1 Career Development Supplemental Form	Form and Instruction	Unchanged	Available
Form 3 Introduction to the Data Tables	Form and Instruction	Unchanged	Available
Form 1 Data Tables	Form and Instruction	Unchanged	Available
Form 1 Attachment 5S PHS 398 Research Training Program Plan Form	Form and Instruction	Unchanged	Available
Form 1 Attachment 5O PHS 398 Research Plan Form	Form and Instruction	Unchanged	Available
Form 1 Attachment 5M PHS 398 Training Subaward Budget Attachment(s) Form	Form and Instruction	Unchanged	Available
Form 2 Attachment 5J PHS 398 Training Budget Instructions	Form and Instruction	Unchanged	Available
Form 1 Attachment 5K PHS 398 Training Budget Form	Form and Instruction	Unchanged	Available
Form 2 Attachment 5H PHS 398 Modular Budget Instructions	Form and Instruction	Unchanged	Available
Form 1 Attachment 5I PHS 398 Modular Budget Form	Form and Instruction	Unchanged	Available
Form 2 Attachment 5F PHS Inclusion Enrollment Report Instructions	Form and Instruction	Unchanged	Available
Form 1 Attachment 5G PHS Inclusion Enrollment Report	Form and Instruction	Unchanged	Available
Form 2 Attachment 5D PHS 398 Cover Page Supplement Instructions	Form and Instruction	Unchanged	Available
Form 1 Attachment 5E PHS 398 Cover Page Supplement Form	Form and Instruction	Unchanged	Available
Form 2 PHS Assignment Request Instruction	Form and Instruction	Unchanged	Available
Form 1 Attachment 5C PHS Assignment Request Form	Form and Instruction	Unchanged	Available
AttC Prior Approval Screen Shots.docx	Supplementary Document	Uploaded 2016-11-10	Available
AttB Revised Appendix Instructions.docx	Supplementary Document	Uploaded 2016-11-10	Available
AttA Revised Biosketch Instructions.docx	Supplementary Document	Uploaded 2016-11-10	Available
OMB Change Request Memo to OMB - 0925-0001 - November 2016.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-11-10	Available
Attachment 11G International Training Tables.docx	Supplementary Document	Uploaded 2016-03-01	Available
11B International Training Tables FINAL DRAFT track changes.docx	Supplementary Document	Uploaded 2016-03-01	Available
OMB Change Request for DITR Tables-2.docx	Supplementary Document	Uploaded 2016-03-01	Available
AttB Revised Biosketch Instructions.docx	Supplementary Document	Uploaded 2016-02-26	Available
AttA Justification for Selected Instructions in 0925-0001 2.26.16.docx	Supplementary Document	Uploaded 2016-02-26	Available
0925-0001 Change Request Memo to OMB - 2.26.2016 sh.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2016-02-26	Available
Attachment 1 Former Revised and New Content of Information Collections 10.2015.docx	Supplementary Document	Uploaded 2015-10-06	Available
Supporting Statement A for 0925-0001 October 2015 ver5 FINAL 10062015.docx	Supporting Statement A	Uploaded 2015-10-06	Repair queued
Attachment 1 Former and Revised Content of Information Collections.docx	Supplementary Document	Uploaded 2015-07-28	Available
Attachment 15 eRA Commons Profile Data Elements.xlsx	Supplementary Document	Uploaded 2015-07-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37814	PHS 398 Paper	Form	Unchanged	PHS 398 Paper Application
37814	PHS 398 Paper	Form and Instruction	Unchanged	PHS 398 Paper Application
217591	PHS 416-5	Form and Instruction	Unchanged	Individual Fellowship Activation Notice
217570	SBIR/STTR Funding Agreement Certification	Form and Instruction	Unchanged	STTR Funding Agreement Certification
217570	SBIR/STTR Funding Agreement Certification	Form and Instruction	Unchanged	SBIR Funding Agreement Certification
217569	VCOC Certification	Form and Instruction	Unchanged	VCOC Certification
217568	PHS 6031	Form and Instruction	Unchanged	PHS 6031
217567	416-1	Form and Instruction	Unchanged	Attachment 7G PHS 416-1 Continuation Page
217567	416-1	Form and Instruction	Unchanged	Attachment 7F PHS 416-1 Checklist Form Page
217567	416-1	Form and Instruction	Unchanged	Attachment 7E PHS 416-1 Face Page 4
217567	416-1	Form and Instruction	Unchanged	Attachment 7D PHS 416-1 Face Page 3
217567	416-1	Form and Instruction	Unchanged	Attachment 7C PHS 416-1 Face Page 2
217567	416-1	Form and Instruction	Unchanged	Attachment 7B PHS 416-1 Face Page 1
217567	416-1	Instruction	Unchanged
217566	Biosketch (Fellowship)	Form and Instruction	Unchanged	Fellowship Applicant Biographical Format Page
217566	Biosketch (Fellowship)	Instruction	Unchanged
217565	PHS Inclusion Enrollment Report	Form and Instruction	Unchanged	Attachment 5G PHS Inclusion Enrollment Report
217565	PHS Inclusion Enrollment Report	Instruction	Unchanged
217564	PHS Assignment Request Form	Form	Unchanged	Attachment 5C PHS Assignment Request Form
217564	PHS Assignment Request Form	Instruction	Unchanged
217563	PHS Fellowship Supplemental Form (includes F reference letters)	Form and Instruction	Unchanged	Fellowship Supplemental Form
217563	PHS Fellowship Supplemental Form (includes F reference letters)	Instruction	Unchanged
217561	Biosketch (424 Electronic)	Form and Instruction	Unchanged	General Biographical Sketch Format Page
217561	Biosketch (424 Electronic)	Instruction	Unchanged
217560	PHS 398 Career Development Award Supplemental Form	Form and Instruction	Unchanged	Career Development Supplemental Form
217560	PHS 398 Career Development Award Supplemental Form	Instruction	Unchanged
217559	Data Tables	Form and Instruction	Unchanged	Introduction to the Data Tables
217559	Data Tables	Form and Instruction	Unchanged	Data Tables
217559	Data Tables	Instruction	Unchanged
217558	PHS 398 Research Training Program Plan	Form and Instruction	Unchanged	Attachment 5S PHS 398 Research Training Program Plan Form
217558	PHS 398 Research Training Program Plan	Instruction	Unchanged
217557	PHS 398 Research Plan	Form and Instruction	Unchanged	Attachment 5O PHS 398 Research Plan Form
217557	PHS 398 Research Plan	Instruction	Unchanged
217556	PHS 398 Training Subaward Budget Attachment(s) Form	Form and Instruction	Unchanged	Attachment 5M PHS 398 Training Subaward Budget Attachment(s) Form
217556	PHS 398 Training Subaward Budget Attachment(s) Form	Instruction	Unchanged
217555	PHS 398 Training Budget	Form and Instruction	Unchanged	Attachment 5J PHS 398 Training Budget Instructions
217555	PHS 398 Training Budget	Form and Instruction	Unchanged	Attachment 5K PHS 398 Training Budget Form
202980	PHS 398 Modular Budget	Form and Instruction	Unchanged	Attachment 5H PHS 398 Modular Budget Instructions
202980	PHS 398 Modular Budget	Form and Instruction	Unchanged	Attachment 5I PHS 398 Modular Budget Form
202979	PHS Inclusion Enrollment Report	Form and Instruction	Unchanged	Attachment 5F PHS Inclusion Enrollment Report Instructions
202979	PHS Inclusion Enrollment Report	Form and Instruction	Unchanged	Attachment 5G PHS Inclusion Enrollment Report
202963	PHS 398 Cover Page Supplement	Form and Instruction	Unchanged	Attachment 5D PHS 398 Cover Page Supplement Instructions
202963	PHS 398 Cover Page Supplement	Form and Instruction	Unchanged	Attachment 5E PHS 398 Cover Page Supplement Form
202959	PHS Assignment Request Form	Form and Instruction	Unchanged	PHS Assignment Request Instruction
202959	PHS Assignment Request Form	Form and Instruction	Unchanged	Attachment 5C PHS Assignment Request Form

ICR Details

OMB Control No: 0925-0001	ICR Reference No: 201611-0925-001
Status: Historical Active	Previous ICR Reference No: 201603-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No: 19797
Title: PHS Applications and Pre-award Related Reporting (OD)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/15/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/15/2016
Terms of Clearance: All materials distributed to respondents (online and paper) must clearly display the approved OMB control number, expiration date, and respective burden hours for the information collections.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2018	10/31/2018	10/31/2018
Responses	420,101	0	420,101
Time Burden (Hours)	850,756	0	850,756
Cost Burden (Dollars)	0	0	0

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Abstract: The National Institutes of Health (NIH) and other Public Health Service (PHS) agencies currently use the Research and Research Training Grant Applications and Related Forms and Ruth L. Kirschstein National Research Service Award (NRSA) Applications and Related Forms (0925-0001). 0925-0001 will expire on August 31, 2015. This 0925-0001 revision submission consolidates application and other related pre-award reporting requirements previously collected under 0925-0001. Post-award reporting requirements, including the Research Performance Progress Report (RPPR), are similarly consolidated and concurrently submitted under 0925-0002 (expiration August 31, 2015).

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Authorizing Statute(s): US Code: 42 USC 285 Name of Law: public Health Serice Act
   US Code: 42 USC 286 Name of Law: Public Health Service Act
   US Code: 42 USC 300 Name of Law: Public Health Service Act
   US Code: 42 USC 288 Name of Law: Public Health Serive Act
   US Code: 42 USC 216 Name of Law: Public health Service Act
   US Code: 42 USC 241 Name of Law: Public Health Service
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 13567	03/16/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 46591	08/05/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 21

table that charts list of burden

IC Title	Form No.	Form Name
416-1	1, 2, 3, 4, 6, 5	Attachment 7B PHS 416-1 Face Page 1 ,   Attachment 7C PHS 416-1 Face Page 2 ,   Attachment 7D PHS 416-1 Face Page 3 ,   Attachment 7E PHS 416-1 Face Page 4 ,   Attachment 7F PHS 416-1 Checklist Form Page ,   Attachment 7G PHS 416-1 Continuation Page
Biosketch (424 Electronic)	1	General Biographical Sketch Format Page
Biosketch (Fellowship)	1	Fellowship Applicant Biographical Format Page
Data Tables	3, 1	Data Tables ,   Introduction to the Data Tables
PHS 398 Career Development Award Supplemental Form	1	Career Development Supplemental Form
PHS 398 Cover Page Supplement	1, 2	Attachment 5E PHS 398 Cover Page Supplement Form ,   Attachment 5D PHS 398 Cover Page Supplement Instructions
PHS 398 Modular Budget	1, 2	Attachment 5I PHS 398 Modular Budget Form ,   Attachment 5H PHS 398 Modular Budget Instructions
PHS 398 Paper	2, 1	PHS 398 Paper Application ,   PHS 398 Paper Application
PHS 398 Research Plan	1	Attachment 5O PHS 398 Research Plan Form
PHS 398 Research Training Program Plan	1	Attachment 5S PHS 398 Research Training Program Plan Form
PHS 398 Training Budget	1, 2	Attachment 5K PHS 398 Training Budget Form ,   Attachment 5J PHS 398 Training Budget Instructions
PHS 398 Training Subaward Budget Attachment(s) Form	1	Attachment 5M PHS 398 Training Subaward Budget Attachment(s) Form
PHS 416-5	1	Individual Fellowship Activation Notice
PHS 6031	1	PHS 6031
PHS Assignment Request Form	1	Attachment 5C PHS Assignment Request Form
PHS Assignment Request Form	2, 1	Attachment 5C PHS Assignment Request Form ,   PHS Assignment Request Instruction
PHS Fellowship Supplemental Form (includes F reference letters)	1	Fellowship Supplemental Form
PHS Inclusion Enrollment Report	1, 2	Attachment 5G PHS Inclusion Enrollment Report ,   Attachment 5F PHS Inclusion Enrollment Report Instructions
PHS Inclusion Enrollment Report	1	Attachment 5G PHS Inclusion Enrollment Report
SBIR/STTR Funding Agreement Certification	1, 2	SBIR Funding Agreement Certification ,   STTR Funding Agreement Certification
VCOC Certification	1	VCOC Certification

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	420,101	420,101	0	0	0	0
Annual Time Burden (Hours)	850,756	850,756	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This submission represents program changes; previous estimated total burden hours for 0925-0001 were 2,051,794; current estimated total burden hours for 0925-0001 is 850,756. This represents a decrease of 1,201,038 hours since the last approval. Although there has been an increase in application submissions, a recalculation of all pre-award burden hours that are broken up by individual form has allowed for a more accurate reflection of the burden placed on the respondents. Overall, the burden hour estimates for PHS forms did not change.

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Annual Cost to Federal Government: $46,070

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/15/2016

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