Information Collection

Information Program on Clinical Trials for Serious and Life-Threatening Diseases: Maintaining a Databank

IC 182781 under ICR 200711-0910-004 · OMB 0910-0459.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0459CMS portion Instrument Data Element Definitions.doc	Other-Data Element Definitions (CMS)

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Element Definitions (CMS)			0459CMS portion Instrument Data Element Definitions.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 745

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	745	745
Annual IC Time Burden (Hours)	4,172	4,172
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.