Information Collection

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

IC 237479 under ICR 202004-0925-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Fellowship Application Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (NCI)	Form and Instruction
Form 2 NCI Summer Curriculum Application Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (NCI)	Form and Instruction
Form 3 Reference Letter Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (NCI)	Form and Instruction
Form 4 Letter of Assurance Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (NCI)	Form and Instruction
Form 5 Proof of Employment Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (NCI)	Form and Instruction
1 Fellowship Application Clean updated Attach 1 with changes.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: Modified

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	Clean updated Attach 1 with changes.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
	Requested	Previously Approved
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.