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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Werner H. Kirsten (WHK) Internship Program Application National Cancer Institute at Frederick (NCI-F)
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
1
Student Application
Attachment 1 - Student Application (Final).pdf
Yes
Yes
Fillable Fileable
Form
2
Mentor Registration
Attachment 2- Mentor_Registration_Screens- Updated.pdf
Yes
Yes
Fillable Fileable
Form
3
Teacher Recommendation
Attachment 3-Teacher Recommendation Wireframe- Updated.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:
Clinical Research: Student Records
FR Citation:
67 FR 60742
Number of Respondents:
460
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
460
0
460
0
0
0
Annual IC Time Burden (Hours)
300
0
300
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 Training_WHK Program 2024-06-25.docx
06/25/2024
Email Correspondence
Attachment 4- Automatic Emails - Full List.pdf
05/27/2024
PIA
Attachment 5 - PIA.pdf
05/27/2024
Privacy Memo
Attachment 6 - Privacy Act Memo Dated June 2024.pdf
06/05/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.