Information Collection

Initital Extramural Applicants

IC 237381 under ICR 202003-0925-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Initital Extramural Applicants	Form and Instruction
1 Applicant Attachment 2 Applicant.pdf	Form and Instruction
1 Applicant Applicant- 03-23-2020.pdf	Form and Instruction
Eligibilty - HD with burden statement.pdf Eligibility - Health Disparities (HD)	IC Document

IC Title:

Initital Extramural Applicants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	1	Applicant	Applicant- 03-23-2020.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: 1,650

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	Previously Approved
Annual Number of Responses for this IC	1,650	1,650
Annual IC Time Burden (Hours)	13,200	13,200
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.