Information Collection

Cancer Prevention Fellowship Program Fellowship Program Application (NCI)

IC 254707 under ICR 202205-0925-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Cancer Prevention Fellowship Program Fellowship Program Application (NCI)	Form and Instruction
1 Fellowship application Attach1_Fellowship Application Applicant Revised.pdf	Form and Instruction
2 reference letters Attach2_Reference Letter Revised.pdf	Form
3 Letter of Assurance Attach3_Letter of Assurance Revised.docx	Form
Mini SSA CPFP Application Systems FINAL (2).docx Mini SSA for CPFP	IC Document
Attach4_SystemGeneratedEmails.pdf email notifications	IC Document
Attach5-Privacy Act Memo.pdf privacy Act Memo	IC Document
Attach6_Privacy Impact Assessment (PIA)_Approved_08192019.pdf PIA	IC Document

IC Title:

Cancer Prevention Fellowship Program Fellowship Program Application (NCI)

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Fellowship application	Attach1_Fellowship Application Applicant Revised.pdf	Yes	Yes	Fillable Fileable
Form	2	reference letters	Attach2_Reference Letter Revised.pdf	Yes	Yes	Fillable Fileable
Form	3	Letter of Assurance	Attach3_Letter of Assurance Revised.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0014; âClinical Research: Student Records

FR Citation: 67 FR 60742

Number of Respondents: 632

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	632	632
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini SSA for CPFP	Mini SSA CPFP Application Systems FINAL (2).docx	07/18/2022
email notifications	Attach4_SystemGeneratedEmails.pdf	07/18/2022
privacy Act Memo	Attach5-Privacy Act Memo.pdf	07/18/2022
PIA	Attach6_Privacy Impact Assessment (PIA)_Approved_08192019.pdf	07/18/2022

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