Information Collection Request

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

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

Forms and Documents
DocumentTypeStatusAvailability
Form 35 CIRB SAE Reviewer Worksheet (Attach 6K) Form and Instruction Modified Repair queued
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 Repair queued
Form 30 Pediatric CIRB Reviewer Findings Amendment to Cooperative Group Protocol (Attach 6F) Form and Instruction Modified Repair queued
Form 29 Adult CIRB Reviewer Findings Amendment Cooperative Group Protocol (Attach 6E) Form and Instruction Modified Repair queued
Form 28 Pediatric CIRB Reviewer Findings Cooperative Group Response to CIRB Review (Attach 6D) Form and Instruction Modified Repair queued
Form 27 Adult CIRB Reviewer Findings Cooperative Group Response to CIRB Review (Attach 6C) Form and Instruction Modified Repair queued
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 Repair queued
Form 23 Summary of CIRB Application Revisions (Attach 5D) Form and Instruction Modified Repair queued
Form 22 Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5C) Form and Instruction Modified Repair queued
Form 21 NCI Pediatric CIRB Application (Attach 5B) Form and Instruction Modified Repair queued
Form 20 NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB) Form and Instruction Modified Repair queued
Form 19 CIRB New Board Member Non-Disclosure Agreement (NDA) (Attach 3E) Form and Instruction Modified Repair queued
Form 18 Direct Deposit Form (Attach 4) Form and Instruction Modified Repair queued
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 Repair queued
Form 15 CIRB New Board Member Biographical Sketch Form (Attach 3B) Form and Instruction Modified Repair queued
Form 14 Study Review Responsibility Transfer Form (SRRT) (Attach 2M) Form and Instruction Modified Repair queued
Form 13 Facilitated Review Acceptance Form (FRAF) (Attach 2L) Form and Instruction Modified Repair queued
Form 12 Request for 30-Day Access Form (Attach 2K) Form and Instruction Modified Repair queued
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 Repair queued
Form 9 Component Institution at Signatory Institution (Attach 2H) Form and Instruction Modified Repair queued
Form 8 IRB at Signatory Institution (Attach 2G) Form and Instruction Modified Repair queued
Form 7 Research Staff at Affiliate Institution (Attach 2F) Form and Instruction Modified Repair queued
Form 6 Investigator at Affiliate Institution (Attach 2E) Form and Instruction Modified Repair queued
Form 5 Research Staff at Signatory Institution (Attach 2D) Form and Instruction Modified Repair queued
Form 4 Investigator at Signatory Institution (Attach 2C) Form and Instruction Modified Repair queued
Form 3 IRB Staff at Signatory Institution's IRB (Attach 2B) Form and Instruction Modified Repair queued
Form 2 NCI CIRB Institution Enrollment Worksheet (Attach 2A) Form and Instruction Modified Repair queued
Form 1 CIRB Helpdesk Survey (Attach 1) Form and Instruction Modified Repair queued
OMB_NCI CIRB_memorandum_May2011.doc Justification for No Material/Nonsubstantive Change Uploaded 2011-05-17 Repair queued
IC Document Collections
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
0925-0625 201106-0925-001
Historical Active 201012-0925-001
HHS/NIH
NIH NCI Central Institutional Review Board (CIRB) Initiative (NCI)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/03/2011
Retrieve Notice of Action (NOA) 06/03/2011
  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

The Central Institutional Review Board Initiative (CIRB www.ncicirb.org) was created to better support medical research efforts by reducing the administrative burden on local Institutional Review Boards and medical researchers while protecting human research participants. Beginning in January 2001, the Adult CIRB has been meeting twice monthly to review Phase 3 Cooperative Group trials. The Pediatric CIRB began reviewing all NCI-approved COG Phase 2, 3 and Pilot protocols beginning in November 2004. Both Boards are composed of individuals who represent a broad range of oncology scientific and nonscientific disciplines covering the public health sector. These may include health professionals such as oncology physicians, nurses, patient representatives, pharmacists, ethicists, and attorneys. As none of the Board members are NCI employees, the Board collectively is made up of public members. There are 6 general areas in which forms are completed. These include CIRB: helpdesk, enrollment, membership, direct deposit, application, and reviewer forms. The enrollment form was developed to collect information for any new sites that are interested in enrolling into the CIRB Initiative. The membership documents were created to collect information on the members of the CIRB. There are currently two Boards (Adult and Pediatric), with 18 members on the Adult Board and 15 members on the Pediatric Board. The application forms are required to be submitted to the CIRB in order to complete a submission for review. The reviewer forms are completed by the Board Members when they submit their reviews. The CIRB Helpdesk Survey seeks to collect information that can be used by the CIRB in a systematic fashion to improve operations and enhance reviewer satisfaction with the initiative. The remainders of the forms are necessary in order to facilitate a complete review of protocols by the CIRB with the absence of conflict of interest in place.

US Code: 42 USC 411 (285a) Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

No

35
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

  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
No
No

$153,574
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Mikia Currie 3014350941

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/03/2011