Information Collection

NCI Adult CIRB Application (Attach 5A)

IC 195543 under ICR 201012-0925-001 · OMB 0925-0625.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0625 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 20 NCI Adult CIRB Application (Attach 5A)	Form and Instruction
20 NCI Adult CIRB Application Attachment 5A - CIRB Adult_Appl_110110.pdf	Form and Instruction

IC Title:

NCI Adult CIRB Application (Attach 5A)

Agency IC Tracking Number:

Is this a Common Form? No

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	20	NCI Adult CIRB Application	Attachment 5A - CIRB Adult_Appl_110110.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0200 "Clinical, Basic and Population-based Research Studies of the Natonal Institutes of Health (NIH), HHS/NIH/OD"

FR Citation: 67 FR 60776

Number of Respondents: 150

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 Potential Violation of the PRA
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	300	300
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.