Information Collection

Initial Intramural Applicants

IC 237383 under ICR 202505-0925-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 Initial Intramural Applicants Form and Instruction
Form 1 Applicant Initial 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 (HD) IC Document
Eligibilty - HD with burden statement.pdf Eligibility Health Disparities (HD) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Initial Intramural Applicants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

Title	Document	Date Uploaded
Eligibility Health Disparities (HD)	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.

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