Information Collection

Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5C)

IC 195545 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 22 Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5C) Form and Instruction
22 Adult/Pediatric CIRB Application - Ancillary Studies Attachment 5C - CIRB_Ancillary App_110110.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5C)	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	22	Adult/Pediatric CIRB Application - Ancillary Studies	Attachment 5C - CIRB_Ancillary App_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: 10	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 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	20	20
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.