Information Collection

Sub-study #19: Addendum to Pilot Study Proposed New Model for the CIRB Participating Institution

IC 199940 under ICR 201008-0925-004 · OMB 0925-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 19 Sub-study #19: Addendum to Pilot Study Proposed New Model for the CIRB Participating Institution	Form and Instruction
19 #19_Attach 19A_19B_CIRB Addendum #19_Attach 19A_19B_CIRB Addendum.docx	Form and Instruction
#19_Gen IC Form_Add CIRB Pilot.docx #19_Gen IC Form_Add CIRB Pilot	IC Document
#19_Justif Memo Attach 19C_19D_19E_CIRB Addendum.docx #19_Justif Memo Attach 19C_19D_19E_CIRB Addendum	IC Document

IC Title:

Sub-study #19: Addendum to Pilot Study Proposed New Model for the CIRB Participating Institution

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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
Form and Instruction	19	#19_Attach 19A_19B_CIRB Addendum	#19_Attach 19A_19B_CIRB Addendum.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD

FR Citation: 67 FR 60743

Number of Respondents: 50

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: 0 %

table that charts list of burden
	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	50	0	0	0	0	0
Annual IC Time Burden (Hours)	30	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
#19_Gen IC Form_Add CIRB Pilot	#19_Gen IC Form_Add CIRB Pilot.docx	10/19/2011
#19_Justif Memo Attach 19C_19D_19E_CIRB Addendum	#19_Justif Memo Attach 19C_19D_19E_CIRB Addendum.docx	10/24/2011

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