Information Collection

Att 6 DLW Protocol and Form.doc

IC 197720 under ICR 201105-0925-003 · OMB 0925-0640.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Att 6 DLW Protocol and Form.doc Att 6 DLW Protocol and Form.doc	Form
4 Att 6 DLW Protocol and Form.doc Att.6 DLW Protocol and Form.doc	Form

IC Title:

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	4				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: SORN #09-25-200, "Clinical, Basic, and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD."

FR Citation: 67 FR 60776

Number of Respondents: 776

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	776	776
Annual IC Time Burden (Hours)	517	517
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.

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