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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.