Information Collection

PHS Fellowship Supplemental Form (includes F reference letters)

IC 217563 under ICR 202210-0925-002 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 15 PHS Fellowship Supplemental Form (includes F reference letters)	Form and Instruction
15 eRA Commons Profile Data Elements Attachment 15_eRA Commons Profile Data Elements_updated 06-25-2021.xlsx	Form and Instruction
15 eRA Commons Profile Data Elements Attachment 15_eRA Commons Profile Data Elements_updated 06-25-2021.xlsx	Form and Instruction
1 PHS Fellowship Supplemental Form Attachment 6B_PHS_Fellowship_Supp_Form_v7.0_FORMS-H.pdf	Form and Instruction
1 PHS Fellowship Supplemental Form Attachment 6B_PHS_Fellowship_Supp_Form_v7.0_FORMS-H.pdf	Form and Instruction
Attachment 6A_PHS Fellowship_Supp_Form_Instructions_FORMS-H.docx PHS Fellowship Supplemental Form	IC Document
Attachment 6A_PHS Fellowship_Supp_Form_Instructions_FORMS-H.docx PHS Fellowship Supplemental Form	IC Document

IC Title:

PHS Fellowship Supplemental Form (includes F reference letters)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	15	eRA Commons Profile Data Elements	Attachment 15_eRA Commons Profile Data Elements_updated 06-25-2021.xlsx		Yes	Yes	Fillable Fileable
Form and Instruction	1	PHS Fellowship Supplemental Form	Attachment 6B_PHS_Fellowship_Supp_Form_v7.0_FORMS-H.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,707

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,707	0	6,707
Annual IC Time Burden (Hours)	87,191	3,353	83,838
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PHS Fellowship Supplemental Form	Attachment 6A_PHS Fellowship_Supp_Form_Instructions_FORMS-H.docx	10/05/2022

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