Information Collection

Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (NCI)

IC 237479 under ICR 201905-0925-004 · OMB 0925-0761.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0761 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (NCI)	Form and Instruction
1 Fellowship Application Attach1_Fellowship Application Applicant.pdf	Form and Instruction
2 NCI Summer Curriculum Application Attach2_NCI Summer Curriculum Application.pdf	Form and Instruction
3 Reference Letter Attach3_Reference Letter.pdf	Form and Instruction
4 Letter of Assurance Attach4_Letter of Assurance.pdf	Form and Instruction
5 Proof of Employment Attach5_Proof of Employment.pdf	Form and Instruction
Mini SSA CPFP Application Systems.docx Mini SSA	IC Document
Attach6_SystemGeneratedEmails.pdf System generated emails	IC Document
Attach7-Privacy Act Memo.pdf Privacy Act Memo	IC Document

IC Title:

Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (NCI)

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Fellowship Application	Attach1_Fellowship Application Applicant.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	NCI Summer Curriculum Application	Attach2_NCI Summer Curriculum Application.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Reference Letter	Attach3_Reference Letter.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	4	Letter of Assurance	Attach4_Letter of Assurance.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	5	Proof of Employment	Attach5_Proof of Employment.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0014 Clinical Research: Student Records, HHS/NIH/OD/OIR/OE

FR Citation: 67 FR 60742

Number of Respondents: 860

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	860	860
Annual IC Time Burden (Hours)	515	515
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini SSA	Mini SSA CPFP Application Systems.docx	08/20/2019
System generated emails	Attach6_SystemGeneratedEmails.pdf	08/20/2019
Privacy Act Memo	Attach7-Privacy Act Memo.pdf	08/20/2019

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