Information Collection Request

NIH NCI Central Institutional Review Board (CIRB) Initiative (NCI)

ICR 201106-0925-001 · OMB 0925-0625 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 35 CIRB SAE Reviewer Worksheet (Attach 6K) Form and Instruction Modified Available
Form 34 CIRB Statistical Reviewer Form (Attach 6J) Form and Instruction Modified Available
Form 33 CIRB Pharmacy Reviewer Form (Attach 6I) Form and Instruction Modified Available
Form 32 Pediatric CIRB Reviewer Findings Continuing Review of Cooperative Group Protocol (Attach 6H) Form and Instruction Modified Available
Form 31 Adult CIRB Reviewer Findings Continuing Review of Cooperative Group Protocol (Attach 6G) Form and Instruction Modified Available
Form 30 Pediatric CIRB Reviewer Findings Amendment to Cooperative Group Protocol (Attach 6F) Form and Instruction Modified Available
Form 29 Adult CIRB Reviewer Findings Amendment Cooperative Group Protocol (Attach 6E) Form and Instruction Modified Available
Form 28 Pediatric CIRB Reviewer Findings Cooperative Group Response to CIRB Review (Attach 6D) Form and Instruction Modified Available
Form 27 Adult CIRB Reviewer Findings Cooperative Group Response to CIRB Review (Attach 6C) Form and Instruction Modified Available
Form 26 Pediatric CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol (Attach 6B) Form and Instruction Modified Available
Form 25 Adult CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol (Attach 6A) Form and Instruction Modified Available
Form 24a Adult/Pediatric CIRB Application for Continuing Review (Attach 5E) Form and Instruction Modified Available
Form 23 Summary of CIRB Application Revisions (Attach 5D) Form and Instruction Modified Available
Form 22 Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5C) Form and Instruction Modified Available
Form 21 NCI Pediatric CIRB Application (Attach 5B) Form and Instruction Modified Available
Form 20 NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB) Form and Instruction Modified Available
Form 19 CIRB New Board Member Non-Disclosure Agreement (NDA) (Attach 3E) Form and Instruction Modified Available
Form 18 Direct Deposit Form (Attach 4) Form and Instruction Modified Available
Form 17 CIRB New Board Member W-9 (Attach 3D) Form and Instruction Modified Available
Form 16 CIRB New Board Member Contact Information Form (Attach 3C) Form and Instruction Modified Available
Form 15 CIRB New Board Member Biographical Sketch Form (Attach 3B) Form and Instruction Modified Available
Form 14 Study Review Responsibility Transfer Form (SRRT) (Attach 2M) Form and Instruction Modified Available
Form 13 Facilitated Review Acceptance Form (FRAF) (Attach 2L) Form and Instruction Modified Available
Form 12 Request for 30-Day Access Form (Attach 2K) Form and Instruction Modified Available
Form 11 Institution Affiliate Institution without an IRB (Attach 2J) Form and Instruction Modified Available
Form 10 IRB at Affiliate Institution (Attach 2I) Form and Instruction Modified Available
Form 9 Component Institution at Signatory Institution (Attach 2H) Form and Instruction Modified Available
Form 8 IRB at Signatory Institution (Attach 2G) Form and Instruction Modified Available
Form 7 Research Staff at Affiliate Institution (Attach 2F) Form and Instruction Modified Available
Form 6 Investigator at Affiliate Institution (Attach 2E) Form and Instruction Modified Available
Form 5 Research Staff at Signatory Institution (Attach 2D) Form and Instruction Modified Available
Form 4 Investigator at Signatory Institution (Attach 2C) Form and Instruction Modified Available
Form 3 IRB Staff at Signatory Institution's IRB (Attach 2B) Form and Instruction Modified Available
Form 2 NCI CIRB Institution Enrollment Worksheet (Attach 2A) Form and Instruction Modified Available
Form 1 CIRB Helpdesk Survey (Attach 1) Form and Instruction Modified Available
OMB_NCI CIRB_memorandum_May2011.doc Justification for No Material/Nonsubstantive Change Uploaded 2011-05-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
195558 CIRB SAE Reviewer Worksheet (Attach 6K) Form and Instruction Modified
195557 CIRB Statistical Reviewer Form (Attach 6J) Form and Instruction Modified
195556 CIRB Pharmacy Reviewer Form (Attach 6I) Form and Instruction Modified
195555 Pediatric CIRB Reviewer Findings Continuing Review of Cooperative Group Protocol (Attach 6H) Form and Instruction Modified
195554 Adult CIRB Reviewer Findings Continuing Review of Cooperative Group Protocol (Attach 6G) Form and Instruction Modified
195553 Pediatric CIRB Reviewer Findings Amendment to Cooperative Group Protocol (Attach 6F) Form and Instruction Modified
195552 Adult CIRB Reviewer Findings Amendment Cooperative Group Protocol (Attach 6E) Form and Instruction Modified
195551 Pediatric CIRB Reviewer Findings Cooperative Group Response to CIRB Review (Attach 6D) Form and Instruction Modified
195550 Adult CIRB Reviewer Findings Cooperative Group Response to CIRB Review (Attach 6C) Form and Instruction Modified
195549 Pediatric CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol (Attach 6B) Form and Instruction Modified
195548 Adult CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol (Attach 6A) Form and Instruction Modified
195547 Adult/Pediatric CIRB Application for Continuing Review (Attach 5E) Form and Instruction Modified
195546 Summary of CIRB Application Revisions (Attach 5D) Form and Instruction Modified
195545 Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5C) Form and Instruction Modified
195544 NCI Pediatric CIRB Application (Attach 5B) Form and Instruction Modified
195543 NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB) Form and Instruction Modified
195542 CIRB New Board Member Non-Disclosure Agreement (NDA) (Attach 3E) Form and Instruction Modified
195541 Direct Deposit Form (Attach 4) Form and Instruction Modified
195540 CIRB New Board Member W-9 (Attach 3D) Form and Instruction Modified
195539 CIRB New Board Member Contact Information Form (Attach 3C) Form and Instruction Modified
195538 CIRB New Board Member Biographical Sketch Form (Attach 3B) Form and Instruction Modified
195537 Study Review Responsibility Transfer Form (SRRT) (Attach 2M) Form and Instruction Modified
195536 Facilitated Review Acceptance Form (FRAF) (Attach 2L) Form and Instruction Modified
195535 Request for 30-Day Access Form (Attach 2K) Form and Instruction Modified
195534 Institution Affiliate Institution without an IRB (Attach 2J) Form and Instruction Modified
195533 IRB at Affiliate Institution (Attach 2I) Form and Instruction Modified
195532 Component Institution at Signatory Institution (Attach 2H) Form and Instruction Modified
195531 IRB at Signatory Institution (Attach 2G) Form and Instruction Modified
195530 Research Staff at Affiliate Institution (Attach 2F) Form and Instruction Modified
195529 Investigator at Affiliate Institution (Attach 2E) Form and Instruction Modified
195528 Research Staff at Signatory Institution (Attach 2D) Form and Instruction Modified
195527 Investigator at Signatory Institution (Attach 2C) Form and Instruction Modified
195526 IRB Staff at Signatory Institution's IRB (Attach 2B) Form and Instruction Modified
195525 NCI CIRB Institution Enrollment Worksheet (Attach 2A) Form and Instruction Modified
195524 CIRB Helpdesk Survey (Attach 1) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2014 01/31/2014 01/31/2014
5,044 0 5,044
2,210 0 2,210
0 0 0





Reginfo record details
35
table that charts list of burden
IC Title Form No. Form Name
Investigator at Signatory Institution (Attach 2C) 4 Investigator at Signatory Institution
Research Staff at Signatory Institution (Attach 2D) 5 Research Staff at Signatory Institution
IRB Staff at Signatory Institution's IRB (Attach 2B) 3 RB Staff at Signatory Institution's IRB
Component Institution at Signatory Institution (Attach 2H) 9 Component Institution at Signatory Institution
IRB at Affiliate Institution (Attach 2I) 10 IRB at Affiliate Institution
Institution Affiliate Institution without an IRB (Attach 2J) 11 Institution Affiliate Institution without an IRB
Request for 30-Day Access Form (Attach 2K) 12 Request for 30-Day Access Form
Facilitated Review Acceptance Form (FRAF) (Attach 2L) 13, 13a, 13a Facilitated Review (FR) Acceptance Form ,   Facilitated Review Acceptance Form (FRAF) ,   Facilitated Review Acceptance Form (FRAF)
Study Review Responsibility Transfer Form (SRRT) (Attach 2M) 14, 14a, 14a Study Review Responsibility Transfer Form ,   Study Review Responsibility Transfer Form ,   Study Review Responsibility Transfer Form (SRRT)
CIRB New Board Member Biographical Sketch Form (Attach 3B) 15 CIRB New Board Member Biographical Sketch Form
CIRB New Board Member Contact Information Form (Attach 3C) 16 CIRB New Board Member Contact Information Form
CIRB New Board Member W-9 (Attach 3D) 17 CIRB New Board Member W-9
Direct Deposit Form (Attach 4) 18 Direct Deposit Form
Pediatric CIRB Reviewer Findings Continuing Review of Cooperative Group Protocol (Attach 6H) 32 Pediatric CIRB Reviewer Findings Continuing Review of Cooperative Group Protocol
CIRB Pharmacy Reviewer Form (Attach 6I) 33 CIRB Pharmacy Reviewer Form
CIRB Statistical Reviewer Form (Attach 6J) 34 CIRB Statistical Reviewer Form
CIRB SAE Reviewer Worksheet (Attach 6K) 35 CIRB SAE Reviewer Worksheet
CIRB New Board Member Non-Disclosure Agreement (NDA) (Attach 3E) 19 CIRB Non-Disclosure Agreement
NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB) 20, 20a, 20a, 36 NCI Adult CIRB Application ,   NCI Adult CIRB Application ,   NCI Adult CIRB Application ,   Adult-Pediatric Treatment Studies
NCI Pediatric CIRB Application (Attach 5B) 21, 21a, 21a NCI Pediatric CIRB Application ,   NCI Pediatric CIRB Application ,   NCI Pediatric CIRB Application
Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5C) 22 Adult/Pediatric CIRB Application - Ancillary Studies
Summary of CIRB Application Revisions (Attach 5D) 23 Summary of CIRB Application Revisions
Adult CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol (Attach 6A) 25 Adult CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol
Pediatric CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol (Attach 6B) 26 Pediatric CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol
Adult/Pediatric CIRB Application for Continuing Review (Attach 5E) 24, 24a, 24a Adult/Pediatric CIRB Application for Continuing Review ,   Adult/Pediatric CIRB Application for Continuing Review ,   Adult/Pediatric CIRB Application for Continuing Review
Adult CIRB Reviewer Findings Cooperative Group Response to CIRB Review (Attach 6C) 27 Adult CIRB Reviewer Findings Cooperative Group Response to CIRB Review
Pediatric CIRB Reviewer Findings Amendment to Cooperative Group Protocol (Attach 6F) 30 Pediatric CIRB Reviewer Findings Amendment to Cooperative Group Protocol
Pediatric CIRB Reviewer Findings Cooperative Group Response to CIRB Review (Attach 6D) 28 Pediatric CIRB Reviewer Findings Cooperative Group Response to CIRB Review
Adult CIRB Reviewer Findings Amendment Cooperative Group Protocol (Attach 6E) 29 Adult CIRB Reviewer Findings Amendment Cooperative Group Protocol
Adult CIRB Reviewer Findings Continuing Review of Cooperative Group Protocol (Attach 6G) 31 Adult CIRB Reviewer Findings Continuing Review of Cooperative Group Protocol
CIRB Helpdesk Survey (Attach 1) 1 CIRB Helpdesk Survey
NCI CIRB Institution Enrollment Worksheet (Attach 2A) 2 NCI CIRB Institution Enrollment Worksheet
Investigator at Affiliate Institution (Attach 2E) 6 Investigator at Affiliate Institution
Research Staff at Affiliate Institution (Attach 2F) 7 Research Staff at Affiliate Institution
IRB at Signatory Institution (Attach 2G) 8 IRB at Signatory Institution

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,044 5,044 0 0 0 0
Annual Time Burden (Hours) 2,210 2,210 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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