Clinical Research Participants

Generic Clearance for Surveys of Customers and other Partners (CC)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0458 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Clinical Research Participants Form
1 Patient Survey 3rd Party Patient Survey.NIH Clinical Center.docx Form
3rd Party Study Mini-Supporting Statement - Clinical Center.docx 3rd Party Study Mini-Supporting Statement - Clinical Center IC Document
3rd Party Study Generic Clearance Form (2).docx 3rd Party Study Generic Clearance Form (2) IC Document
3rd Party Study Mini-Supporting Statement REVISED - Clinical Center (2).docx 3rd Party Study Mini-Supporting Statement REVISED - Clinical Center (2) IC Document

Information Collection (IC) Details

IC Title:	Clinical Research Participants	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Patient Survey	3rd Party Patient Survey.NIH Clinical Center.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 378	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	378	0	0	0	0	0
Annual IC Time Burden (Hours)	38	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
3rd Party Study Mini-Supporting Statement - Clinical Center	3rd Party Study Mini-Supporting Statement - Clinical Center.docx	04/13/2011
3rd Party Study Generic Clearance Form (2)	3rd Party Study Generic Clearance Form (2).docx	04/13/2011
3rd Party Study Mini-Supporting Statement REVISED - Clinical Center (2)	3rd Party Study Mini-Supporting Statement REVISED - Clinical Center (2).docx	04/21/2011

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