Information Collection

Phs 2590

IC 217418 under ICR 201708-0925-003 · OMB 0925-0002.

⚠️ Notice: This information collection may be referencing outdated material.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 11 PHS 2590 Form
11 PHS 2590 Forms Attachment 3 PHS 2590 Forms.doc Form
12 Trainee Diversity Report Attachment 7 - Trainee Diversity Report-1.docx Form
13 General Biographical Sketch Format Page Attachment 8A General Biographical Sketch Format Page.docx Form
14 Fellowship Applicant Biographical Sketch Format Page Attachment 9A Fellowship Applicant Biographical Sketch Format Page.docx Form
15 Fellowship Applicant Biographical Sketch Postdoctoral Sa Attachment 9B Fellowship Applicant Biographical Sketch Postdoctoral Sample.docx Form
16 Fellowship Applicant Biographical Sketch Predoctoral Sam Attachment 9C Fellowship Applicant Biographical Sketch Predoctoral Sample.docx Form
Attachment 4 PHS 2590 Instructions.docx PHS 2590 Instructions IC Document
Attachment 8B General and Fellowship Biographical Sketch Instructions.docx General and Fellowship Biographical Sketch Instructions IC Document
Attachment 10A Introduction to the Data Tables.docx Introduction to the Data Tables IC Document
Attachment 10B Undergraduate Training Tables.docx Undergraduate Training Tables IC Document
Attachment 10C Consolidated Training Tables.docx Consolidated Training Tables IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PHS 2590	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	11	PHS 2590 Forms	Attachment 3 PHS 2590 Forms.doc	Yes	Yes	Fillable Fileable
Form	12	Trainee Diversity Report	Attachment 7 - Trainee Diversity Report-1.docx	Yes	Yes	Fillable Fileable
Form	13	General Biographical Sketch Format Page	Attachment 8A General Biographical Sketch Format Page.docx	Yes	Yes	Fillable Fileable
Form	14	Fellowship Applicant Biographical Sketch Format Page	Attachment 9A Fellowship Applicant Biographical Sketch Format Page.docx	Yes	Yes	Fillable Fileable
Form	15	Fellowship Applicant Biographical Sketch Postdoctoral Sample	Attachment 9B Fellowship Applicant Biographical Sketch Postdoctoral Sample.docx	Yes	Yes	Fillable Fileable
Form	16	Fellowship Applicant Biographical Sketch Predoctoral Sample	Attachment 9C Fellowship Applicant Biographical Sketch Predoctoral Sample.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 243	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	243	243
Annual IC Time Burden (Hours)	4,374	4,374
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PHS 2590 Instructions	Attachment 4 PHS 2590 Instructions.docx	01/25/2017
General and Fellowship Biographical Sketch Instructions	Attachment 8B General and Fellowship Biographical Sketch Instructions.docx	01/25/2017
Introduction to the Data Tables	Attachment 10A Introduction to the Data Tables.docx	01/25/2017
Undergraduate Training Tables	Attachment 10B Undergraduate Training Tables.docx	01/25/2017
Consolidated Training Tables	Attachment 10C Consolidated Training Tables.docx	01/25/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.