416-1

PHS Applications and Pre-award Related Reporting (OD)

Documents and Forms

Document Name Document Type
Attachment 7A PHS416-1 Fellowship_Transfer instructions.pdf.docx Instruction
1 Form Attachment 7B PHS 416-1 face page 1.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
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
6 Form Attachment 7G PHS 416-1 continuation page.docx Form
7 Form Attachment 7H PHS 416-1 performancesites.docx Form

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 7A PHS416-1 Fellowship_Transfer instructions.pdf.docx	Yes	Yes	Printable Only
Form	1	Form	Attachment 7B PHS 416-1 face page 1.docx	Yes	Yes	Fillable Fileable
Form	2	Form	Attachment 7C PHS 416-1 face page 2.docx	Yes	Yes	Fillable Fileable
Form	3	Form	Attachment 7D PHS 416-1 face page 3.docx	Yes	Yes	Fillable Fileable
Form	4	Form	Attachment 7E PHS 416-1 face page 4_FORMS-I.docx	Yes	Yes	Fillable Fileable
Form	5	Form	Attachment 7F PHS 416-1checklist form page.docx	Yes	Yes	Fillable Fileable
Form	6	Form	Attachment 7G PHS 416-1 continuation page.docx	Yes	Yes	Fillable Fileable
Form	7	Form	Attachment 7H PHS 416-1 performancesites.docx	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 %

	Requested	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

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.