Information Collection

Attach 1Z - USMCI 8214/Z6091 Crossover Request/Checklist Transmittal Form

IC 195178 under ICR 201211-0925-011 · OMB 0925-0624.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0624 can be found here:

Documents and Forms

Document Name Document Type
Form 26 Attach 1Z - USMCI 8214/Z6091 Crossover Request/Checklist Transmittal Form Form and Instruction
26 Attach 1Z - USMCI 8214/Z6091 Crossover Request/Checklist attach_1z_8214crsov.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attach 1Z - USMCI 8214/Z6091 Crossover Request/Checklist Transmittal Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	26	Attach 1Z - USMCI 8214/Z6091 Crossover Request/Checklist Transmittal Form	attach_1z_8214crsov.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH), HHS/NIH/OD	FR Citation: 67 FR 60776

Number of Respondents: 5	Number of Respondents for Small Entity: 2

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.