Information Collection

Epidemiological Research Request -- Federal Entities

IC 183744 under ICR 201010-0960-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Epidemiological Research Request -- Federal Entities Form and Instruction
Epidemiological Research Review Epidemiological Research Review Information, Application and Confidentiality Agreement.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Epidemiological Research Request -- Federal Entities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 401.165

Information Collection 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: 2	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2	2
Annual IC Time Burden (Hours)	-4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.