Information Collection

416-1

IC 202963 under ICR 201210-0925-001 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 7A PHS 416-1 Instructions.doc	Instruction
7B Face Page Attachment 7B PHS 416-1 Face Page 1.pdf	Form and Instruction
7C Face Page 3 Attachment 7C PHS 416-1 Face Page 3.pdf	Form and Instruction
7D Project Performance Site Format Attachment 7D PHS 416-1 Project Performance Site Format Page.pdf	Form and Instruction
7E Face Page 4 Attachment 7E PHS 416-1 Face Page 4.pdf	Form and Instruction
7F SPONSOR/CO-SPONSOR BIOGRAPHICAL SKETCH Attachment 7F PHS 416-1 Sponsor Biosketch Format Page.doc	Form and Instruction
7G Checklist Form Page Attachment 7G PHS 416-1 Checklist Form Page.pdf	Form and Instruction
7H Continuation Page Attachment 7H PHS 416-1 Continuation Page.pdf	Form and Instruction
7C Face Page 2 Attachment 7C PHS 416-1 Face Page 2.pdf	Form and Instruction

IC Title:

416-1

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.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 7A PHS 416-1 Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	7B	Face Page	Attachment 7B PHS 416-1 Face Page 1.pdf	Yes	Yes	Paper Only
Form and Instruction	7C	Face Page 3	Attachment 7C PHS 416-1 Face Page 3.pdf	Yes	Yes	Paper Only
Form and Instruction	7D	Project Performance Site Format	Attachment 7D PHS 416-1 Project Performance Site Format Page.pdf	Yes	Yes	Paper Only
Form and Instruction	7E	Face Page 4	Attachment 7E PHS 416-1 Face Page 4.pdf	Yes	Yes	Paper Only
Form and Instruction	7F	SPONSOR/CO-SPONSOR BIOGRAPHICAL SKETCH	Attachment 7F PHS 416-1 Sponsor Biosketch Format Page.doc	Yes	Yes	Paper Only
Form and Instruction	7G	Checklist Form Page	Attachment 7G PHS 416-1 Checklist Form Page.pdf	Yes	Yes	Paper Only
Form and Instruction	7H	Continuation Page	Attachment 7H PHS 416-1 Continuation Page.pdf	Yes	Yes	Paper Only
Form and Instruction	7C	Face Page 2	Attachment 7C PHS 416-1 Face Page 2.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30	30
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.