Information Collection

NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB)

IC 195543 under ICR 201106-0925-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 20 NCI Adult CIRB Application NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB)	Form and Instruction
Form 20a NCI Adult CIRB Application NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB)	Form and Instruction
Form 20a NCI Adult CIRB Application NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB)	Form and Instruction
Form 36 Adult-Pediatric Treatment Studies NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB)	Form and Instruction
20 NCI Adult CIRB Application Attachment 5A - CIRB Adult_Appl_110110.pdf	Form and Instruction
20a NCI Adult CIRB Application Attach 5A - CIRB Adult_Change with Highlights.pdf	Form and Instruction
20a NCI Adult CIRB Application Attach 5A - CIRB Adult_NEW.pdf	Form and Instruction
36 Adult-Pediatric Treatment Studies Attach 5AB - Adult-Peds Treat Studies_NEW.pdf	Form and Instruction

IC Title:

NCI Adult CIRB Application (Attach 5A) and Adult-Peds Treatment Studies (Attach 5AB)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	20	Yes	Yes	Fillable Fileable
Form and Instruction	20a	Yes	Yes	Fillable Fileable
Form and Instruction	20a	Yes	Yes	Fillable Fileable
Form and Instruction	36	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: 150

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	300	300
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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