Information Collection

Official Statement Relinquishing Interests & Rights In A Public Health Service Research Grant

IC 111172 under ICR 197511-0925-001 · OMB 0925-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0004 can be found here:

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IC Title:	OFFICIAL STATEMENT RELINQUISHING INTERESTS & RIGHTS IN A PUBLIC HEALTH SERVICE RESEARCH GRANT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PHS 3734				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

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