416-1

PHS Applications and Pre-award Related Reporting (OD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Document Name Document Type
Attachment 7A PHS 416-1 Instructions.doc Instruction
7B Face Page Attachment 7B PHS 416-1 Face Page 1.pdf Form and Instruction
7C Face Page 3 Attachment 7C PHS 416-1 Face Page 3.pdf Form and Instruction
7D Project Performance Site Format Attachment 7D PHS 416-1 Project Performance Site Format Page.pdf Form and Instruction
7E Face Page 4 Attachment 7E PHS 416-1 Face Page 4.pdf Form and Instruction
7F SPONSOR/CO-SPONSOR BIOGRAPHICAL SKETCH Attachment 7F PHS 416-1 Sponsor Biosketch Format Page.doc Form and Instruction
7G Checklist Form Page Attachment 7G PHS 416-1 Checklist Form Page.pdf Form and Instruction
7H Continuation Page Attachment 7H PHS 416-1 Continuation Page.pdf Form and Instruction
7C Face Page 2 Attachment 7C PHS 416-1 Face Page 2.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	416-1	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 7A PHS 416-1 Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	7B	Face Page	Attachment 7B PHS 416-1 Face Page 1.pdf	Yes	Yes	Paper Only
Form and Instruction	7C	Face Page 3	Attachment 7C PHS 416-1 Face Page 3.pdf	Yes	Yes	Paper Only
Form and Instruction	7D	Project Performance Site Format	Attachment 7D PHS 416-1 Project Performance Site Format Page.pdf	Yes	Yes	Paper Only
Form and Instruction	7E	Face Page 4	Attachment 7E PHS 416-1 Face Page 4.pdf	Yes	Yes	Paper Only
Form and Instruction	7F	SPONSOR/CO-SPONSOR BIOGRAPHICAL SKETCH	Attachment 7F PHS 416-1 Sponsor Biosketch Format Page.doc	Yes	Yes	Paper Only
Form and Instruction	7G	Checklist Form Page	Attachment 7G PHS 416-1 Checklist Form Page.pdf	Yes	Yes	Paper Only
Form and Instruction	7H	Continuation Page	Attachment 7H PHS 416-1 Continuation Page.pdf	Yes	Yes	Paper Only
Form and Instruction	7C	Face Page 2	Attachment 7C PHS 416-1 Face Page 2.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	300	300
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.