Information Collection

Att.19 CHAMPS Activities Questionnaire

IC 197732 under ICR 201105-0925-003 · OMB 0925-0640.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 16 Att.19 CHAMPS Activities Questionnaire	Form
16 Att.19 CHAMPS Activities Questionnaire Att.19 CHAMPS Activities Questionnaire.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	16	Att.19 CHAMPS Activities Questionnaire	Att.19 CHAMPS Activities Questionnaire.doc		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: 742

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	1,484	1,484
Annual IC Time Burden (Hours)	371	371
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.