Application Forms for the NIDA Summer Research Internship Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Student Application Form	Form and Instruction	New	Available
Form 1 Attachment 1 Student Application Form	Form and Instruction	Removed	Available
Form 1 Attachment 1 Student Application Form	Form and Instruction	Removed	Available
pub 30day FRN2019-23283.pdf	Supplementary Document	Uploaded 2019-10-28	Available
Attachment 4 - HHS Privacy Impact Assessment (PIA) Form.docx	Supplementary Document	Uploaded 2019-10-28	Available
Attachment 3 - NIDA SRIP Privacy Act Memo.pdf	Supplementary Document	Uploaded 2019-10-28	Available
Attachment 2 - NIH 2019 High School Internship Program Policy FINAL 10-9-18.pdf	Supplementary Document	Uploaded 2019-10-28	Available
Support Statement A NIDA Summer Research Internship 2020 (7).docx	Supporting Statement A	Uploaded 2019-10-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238310	Student Application Form	Form and Instruction	New	Student Application Form
219962	Student Application Form Undergraduates	Form and Instruction	Removed	Attachment 1 Student Application Form
219961	Student Application Form High School Students	Form and Instruction	Removed	Attachment 1 Student Application Form

ICR Details

OMB Control No: 0925-0738	ICR Reference No: 201910-0925-002
Status: Historical Active	Previous ICR Reference No: 201602-0925-004
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Application Forms for the NIDA Summer Research Internship Program
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/29/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2022	36 Months From Approved
Responses	250	0	0
Time Burden (Hours)	250	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The NIDA Summer Research Internship Program introduces undergraduate students to substance abuse and addiction research through internships with NIDA grantees at universities across the United States and Puerto Rico, with a goal of enhancing the number of underrepresented minorities in biomedical research. Students intern with NIDA principal investigators for eight weeks during the summer. For many of these interns, it was their first research experience and the exposure to novel and state-of-the-art science was invaluable. This opportunity has served as an introduction to the research process for many STEM students and provided the hands-on experience needed when considering a career in biomedical research.

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Authorizing Statute(s): US Code: 42 USC sections 241 and 282(b)(13) Name of Law: Public Health Service Act
  

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:
	84 FR 8881	03/12/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 57457	10/25/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Student Application Form	1	Student Application Form
Student Application Form High School Students	1	Attachment 1 Student Application Form
Student Application Form Undergraduates	1	Attachment 1 Student Application Form

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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	250	0	0	-100	0	350
Annual Time Burden (Hours)	250	0	0	-100	0	350
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The program no longer accepts high school students due to the new NIH High School Summer Internship Program Policy (see Attachment 2), so the minimum age requirement had to be adjusted to 18 years old. The new policy requires an on-site coordinator as well as other requirements in order to provide internships to minors, which we cannot guarantee, thus the minimum age requirement for program eligibility program has been adjusted to 18 years old.

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Annual Cost to Federal Government: $108,661

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 10/29/2019

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