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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cancer Prevention Fellowship Program Fellowship Program Application (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 Revised.pdf
Yes
Yes
Fillable Fileable
Form
2
reference letters
Attach2_Reference Letter Revised.pdf
Yes
Yes
Fillable Fileable
Form
3
Letter of Assurance
Attach3_Letter of Assurance Revised.docx
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
FR Citation:
67 FR 60742
Number of Respondents:
632
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
632
0
632
0
0
0
Annual IC Time Burden (Hours)
288
0
288
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Mini SSA for CPFP
Mini SSA CPFP Application Systems FINAL (2).docx
07/18/2022
email notifications
Attach4_SystemGeneratedEmails.pdf
07/18/2022
privacy Act Memo
Attach5-Privacy Act Memo.pdf
07/18/2022
PIA
Attach6_Privacy Impact Assessment (PIA)_Approved_08192019.pdf
07/18/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.