Information Collection

Initial Intramural Applicants

IC 237383 under ICR 201908-0925-005 · OMB 0925-0361.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0361 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Initial Intramural Applicants	Form and Instruction
1 Applicant Attachment 2 Applicant.pdf	Form and Instruction
Eligibilty - HD with burden statement.pdf Eligibility Health Disparities (HD)	IC Document

IC Title:

Initial Intramural Applicants

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	1	Applicant	Attachment 2 Applicant.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: DHHS 09-25-0165 National Institutes of Health (NIH) Office of Loan Repayment and Scholarship (OLRPS) Record System, HHS/NIH/OD

FR Citation: 67 FR 60742

Number of Respondents: 40

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Eligibility Health Disparities (HD)	Eligibilty - HD with burden statement.pdf	08/15/2019

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