Information Collection

PMR/F Fellowship Applicants

IC 226159 under ICR 201703-0920-011 · OMB 0920-0765.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0765 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0765 PMR/F Fellowship Applicants Form
0920-0765 Attachment_2-Original FMS_Application_Module Attachment_2-Original FMS_Application_Module.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PMR/F Fellowship 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	0920-0765	Attachment_2-Original FMS_Application_Module	Attachment_2-Original FMS_Application_Module.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	30	30
Annual IC Time Burden (Hours)	60	60
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.