Information Collection

416-1

IC 217567 under ICR 202408-0925-001 · OMB 0925-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Form 416-1	Form
Form 2 Form 416-1	Form
Form 3 Form 416-1	Form
Form 4 Form 416-1	Form
Form 5 Form 416-1	Form
Form 6 Form 416-1	Form
Form 7 Form 416-1	Form
Attachment 7A PHS416-1 Fellowship_Transfer instructions.pdf.docx	Instruction
Attachment 7A PHS416-1 Fellowship_Transfer instructions.pdf.docx	Instruction
1 Form Attachment 7B PHS 416-1 face page 1.docx	Form
1 Form Attachment 7B PHS 416-1 face page 1.docx	Form
2 Form Attachment 7C PHS 416-1 face page 2.docx	Form
2 Form Attachment 7C PHS 416-1 face page 2.docx	Form
3 Form Attachment 7D PHS 416-1 face page 3.docx	Form
3 Form Attachment 7D PHS 416-1 face page 3.docx	Form
4 Form Attachment 7E PHS 416-1 face page 4_FORMS-I.docx	Form
4 Form Attachment 7E PHS 416-1 face page 4_FORMS-I.docx	Form
5 Form Attachment 7F PHS 416-1checklist form page.docx	Form
5 Form Attachment 7F PHS 416-1checklist form page.docx	Form
6 Form Attachment 7G PHS 416-1 continuation page.docx	Form
6 Form Attachment 7G PHS 416-1 continuation page.docx	Form
7 Form Attachment 7H PHS 416-1 performancesites.docx	Form
7 Form Attachment 7H PHS 416-1 performancesites.docx	Form

IC Title:

416-1

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Printable Only
Form	1	Yes	Yes	Fillable Fileable
Form	2	Yes	Yes	Fillable Fileable
Form	3	Yes	Yes	Fillable Fileable
Form	4	Yes	Yes	Fillable Fileable
Form	5	Yes	Yes	Fillable Fileable
Form	6	Yes	Yes	Fillable Fileable
Form	7	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 29

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	29	29
Annual IC Time Burden (Hours)	290	290
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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