Information Collection

PHS Fellowship Supplemental Form (includes F reference letters)

IC 217563 under ICR 201707-0925-001 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13 PHS Fellowship Supplemental Form (includes F reference letters)	Form
13 PHS Fellowship Supplement Form Attachment 6B PHS Fellowship Supplemental Form.docx	Form
Attachment 6A PHS Fellowship Supplemental Form Instructions.docx Attachment 6A PHS Fellowship Supplemental Form Instructions	IC Document

IC Title:

PHS Fellowship Supplemental Form (includes F reference letters)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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	13	PHS Fellowship Supplement Form	Attachment 6B PHS Fellowship Supplemental Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,707

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	6,707	6,707
Annual IC Time Burden (Hours)	83,838	83,838
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 6A PHS Fellowship Supplemental Form Instructions	Attachment 6A PHS Fellowship Supplemental Form Instructions.docx	01/25/2017

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