Information Collection

Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information

IC 203094 under ICR 201108-0925-002 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information	Form and Instruction
1 Join CCR Mailing List #14_Attach 1_Join Our Mailing List.doc	Form and Instruction
2 Update CCR Mailing List #14_Attach 2_Update Your Profile.doc	Form and Instruction
#14_Request_CCR_06_20_12.doc Request for CCR Mailing List	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Sub-study #14 - CCR Clinical Trials at NIH - Join Our Mailing List/Update Your Profile Business Contact Information

Agency IC Tracking Number:

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 and Instruction	1	Join CCR Mailing List	#14_Attach 1_Join Our Mailing List.doc		Yes	Yes	Fillable Fileable
Form and Instruction	2	Update CCR Mailing List	#14_Attach 2_Update Your Profile.doc		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"

FR Citation: 67 FR 60743

Number of Respondents: 1,600

Number of Respondents for Small Entity: 1,600

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,600	0	0	0	0	0
Annual IC Time Burden (Hours)	133	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for CCR Mailing List	#14_Request_CCR_06_20_12.doc	06/20/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.