Information Collection

Epidemiological Research Request -- Private Entities

IC 183743 under ICR 200802-0960-004 · OMB 0960-0701.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0701 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Epidemiological Research Request -- Private Entities	Form and Instruction
Epidemiological Research Review Epidemiological Research Review Information, Application and Confidentiality Agreement.pdf	Form and Instruction

IC Title:

Epidemiological Research Request -- Private Entities

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 401.165

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
Form and Instruction	N/A	Epidemiological Research Review	Epidemiological Research Review Information, Application and Confidentiality Agreement.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	26	26
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.