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Student Application Form
Application Forms for the NIDA Summer Research Internship Program
OMB: 0925-0738
IC ID: 238310
OMB.report
HHS/NIH
OMB 0925-0738
ICR 202212-0925-003
IC 238310
( )
Documents and Forms
Document Name
Document Type
Form 1
Student Application Form
Form and Instruction
1 Student Application Form
Attachment 1 - Student Application Form.pdf
Form and Instruction
1 Student Application Form
Attachment 1 - Student Application Form.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Student Application Form
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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
Student Application Form
Attachment 1 - Student Application Form.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:
09-25-0014, Clinical Research: Student Records, HHS>NIH/OD/OIR/OE
FR Citation:
67 FR 60742
Number of Respondents:
300
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
300
0
50
0
0
250
Annual IC Time Burden (Hours)
300
0
50
0
0
250
Annual IC Cost Burden (Dollars)
0
0
0
0
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.