Information Collection

Researchers

IC 199531 under ICR 201109-0925-005 · OMB 0925-0652.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0652 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Researchers	Form and Instruction
1 Funding Source Questionnaire Attachment 1- FUNDING SOURCE QUESTIONNAIRE v5.doc	Form and Instruction
Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2.docx Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2	IC Document

IC Title:

Researchers

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 and Instruction	1	Funding Source Questionnaire	Attachment 1- FUNDING SOURCE QUESTIONNAIRE v5.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,840

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,840	1,840
Annual IC Time Burden (Hours)	147	147
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2	Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2.docx	09/14/2011

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