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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cancer Prevention Fellowship Program Fellowship Program and Summer Curriculum Applications (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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
Fellowship Application
Attach1_Fellowship Application Applicant.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
2
NCI Summer Curriculum Application
Attach2_NCI Summer Curriculum Application.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
3
Reference Letter
Attach3_Reference Letter.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
4
Letter of Assurance
Attach4_Letter of Assurance.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
5
Proof of Employment
Attach5_Proof of Employment.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
09-25-0014 Clinical Research: Student Records, HHS/NIH/OD/OIR/OE
FR Citation:
67 FR 60742
Number of Respondents:
860
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
860
0
860
0
0
0
Annual IC Time Burden (Hours)
515
0
515
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Mini SSA
Mini SSA CPFP Application Systems.docx
08/20/2019
System generated emails
Attach6_SystemGeneratedEmails.pdf
08/20/2019
Privacy Act Memo
Attach7-Privacy Act Memo.pdf
08/20/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.