416-1

Individual Ruth L. Kirschstein National Research Service Award Applications and Related Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0002 can be found here:

Documents and Forms

Document Name Document Type
Form 7 416-1 Form and Instruction
1 form 416-1applicant-fellowbiosketch.docm Form and Instruction
2 form 416-1applicant-fellowbiosketchsample.docm Form and Instruction
3 form 416-1checklist (2).docm Form and Instruction
4 form 416-1cont.docm Form and Instruction
5 form 416-1fp1.docm Form and Instruction
6 form 416-1fp2.docm Form and Instruction
7 form 416-1fp3.docm Form and Instruction
8 form 416-1fp4.docm Form and Instruction
9 form 416-1fp5.docm Form and Instruction
10 form 416-1-Inclusion enrollment_report.docm Form and Instruction
11 form 416-1personal.docm Form and Instruction
13 form 416-1sponsorbiosketch.docm Form and Instruction
14 form 416-1sponsorbiosketchsample.docm Form and Instruction
15 form 416-1-Targeted_Planned enrollment_table.docm Form and Instruction
16 form 416- optional additional performance sites.docm Form and Instruction

Information Collection (IC) Details

IC Title:	416-1	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form and Instruction	7	form	416-1fp3.docm	Yes	Yes	Paper Only
Form and Instruction	8	form	416-1fp4.docm	Yes	Yes	Paper Only
Form and Instruction	9	form	416-1fp5.docm	No	No	Paper Only
Form and Instruction	10	form	416-1-Inclusion enrollment_report.docm	Yes	Yes	Paper Only
Form and Instruction	11	form	416-1personal.docm	Yes	Yes	Paper Only
Form and Instruction	13	form	416-1sponsorbiosketch.docm	Yes	Yes	Paper Only
Form and Instruction	14	form	416-1sponsorbiosketchsample.docm	Yes	Yes	Paper Only
Form and Instruction	15	form	416-1-Targeted_Planned enrollment_table.docm	Yes	Yes	Paper Only
Form and Instruction	16	form	416- optional additional performance sites.docm	Yes	Yes	Paper Only
Form and Instruction	1	form	416-1applicant-fellowbiosketch.docm	Yes	Yes	Paper Only
Form and Instruction	2	form	416-1applicant-fellowbiosketchsample.docm	Yes	Yes	Paper Only
Form and Instruction	3	form	416-1checklist (2).docm	Yes	Yes	Paper Only
Form and Instruction	4	form	416-1cont.docm	Yes	Yes	Paper Only
Form and Instruction	5	form	416-1fp1.docm	Yes	Yes	Paper Only
Form and Instruction	6	form	416-1fp2.docm	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,900	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,900	4,900
Annual IC Time Burden (Hours)	98,000	98,000
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.