Information Collection

Phs 2590

IC 217418 under ICR 202006-0925-003 · OMB 0925-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 11 PHS 2590 Forms PHS 2590	Form
Form 12 Trainee Diversity Report PHS 2590	Form
Form 13 General Biographical Sketch Format Page PHS 2590	Form
Form 14 Fellowship Applicant Biographical Sketch Format Page PHS 2590	Form
Form 15 Fellowship Applicant Biographical Sketch Postdoctoral Sample PHS 2590	Form
Form 16 Fellowship Applicant Biographical Sketch Predoctoral Sample PHS 2590	Form
11 PHS 2590 Forms Attachment 3 PHS 2590 Forms.doc	Form
12 Trainee Diversity Report Attachment 7 - Trainee Diversity Report-1.docx	Form
13 General Biographical Sketch Format Page Attachment 8A General Biographical Sketch Format Page.docx	Form
14 Fellowship Applicant Biographical Sketch Format Page Attachment 9A Fellowship Applicant Biographical Sketch Format Page.docx	Form
15 Fellowship Applicant Biographical Sketch Postdoctoral Sa Attachment 9B Fellowship Applicant Biographical Sketch Postdoctoral Sample.docx	Form
16 Fellowship Applicant Biographical Sketch Predoctoral Sam Attachment 9C Fellowship Applicant Biographical Sketch Predoctoral Sample.docx	Form
Attachment 4 PHS 2590 Instructions.docx PHS 2590 Instructions	IC Document
Attachment 8B General and Fellowship Biographical Sketch Instructions.docx General and Fellowship Biographical Sketch Instructions	IC Document
Attachment 10A Introduction to the Data Tables.docx Introduction to the Data Tables	IC Document
Attachment 10B Undergraduate Training Tables.docx Undergraduate Training Tables	IC Document
Attachment 10C Consolidated Training Tables.docx Consolidated Training Tables	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

PHS 2590

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	11	Yes	Yes	Fillable Fileable
Form	12	Yes	Yes	Fillable Fileable
Form	13	Yes	Yes	Fillable Fileable
Form	14	Yes	Yes	Fillable Fileable
Form	15	Yes	Yes	Fillable Fileable
Form	16	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 243

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	243	243
Annual IC Time Burden (Hours)	4,374	4,374
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PHS 2590 Instructions		01/25/2017
General and Fellowship Biographical Sketch Instructions		01/25/2017
Introduction to the Data Tables		01/25/2017
Undergraduate Training Tables		01/25/2017
Consolidated Training Tables		01/25/2017

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

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