Information Collection

Renewal Intramural Applicants

IC 237384 under ICR 202208-0925-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Renewal Intramural Applicants	Form and Instruction
1 Applicant Applicant 07-27-2022.pdf	Form and Instruction
1 Applicant Applicant 07-27-2022.pdf	Form and Instruction
Eligibilty - HD with burden statement.pdf Eligibility Health Disparities	IC Document
Eligibilty - HD with burden statement.pdf Eligibility Health Disparities	IC Document

IC Title:

Renewal Intramural 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	Applicant 07-27-2022.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: 40

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	40	40
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Eligibility Health Disparities	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.