Information Collection

Doctors, Students and Others

IC 189079 under ICR 201212-0925-002 · OMB 0925-0602.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0602 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 MSRP Doctors, Students and Others	Form and Instruction
Form 2 IPPCR Doctors, Students and Others	Form and Instruction
Form 3 PCP Doctors, Students and Others	Form and Instruction
Form 4 CEP Doctors, Students and Others	Form and Instruction
Form 5 GME Doctors, Students and Others	Form and Instruction
Form 6 REP Doctors, Students and Others	Form and Instruction
Form 7 Duke Alumni Survey Doctors, Students and Others	Form and Instruction
Form 8 Sabbatical in Clinical Research Management Doctors, Students and Others	Form and Instruction
Form 9 Ph.D Student Simmer Course Doctors, Students and Others	Form and Instruction
Form 10 Summer Internship Survey Doctors, Students and Others	Form and Instruction
1 MSRP MRSP-CRTP Alumni Survey-Screen Shots.pdf	Form and Instruction
2 IPPCR IPPCR 12 Month Survey Screenshots.pdf	Form and Instruction
3 PCP PCP Alumni Survey 1yr Screenshots.pdf	Form and Instruction
4 CEP Clinical Electives Program Alumni Survey-Screen Shots.pdf	Form and Instruction
5 GME GME Alumni Survey Screen Shots.pdf	Form and Instruction
6 REP Resident Elective Participant Survey.pdf	Form and Instruction
7 Duke Alumni Survey NIH-Duke Program Alumni Survey.pdf	Form and Instruction
8 Sabbatical in Clinical Research Management Sabbatical 1 Year Followup Survey.pdf	Form and Instruction
9 Ph.D Student Simmer Course PhD Student Summer Course 1 Year Followup Survey.pdf	Form and Instruction
10 Summer Internship Survey Summer Internship Program Alumni Survey.pdf	Form and Instruction

IC Title:

Doctors, Students and Others

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	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable
Form and Instruction	5	Yes	Yes	Fillable Fileable
Form and Instruction	6	Yes	Yes	Fillable Fileable
Form and Instruction	7	Yes	Yes	Fillable Fileable
Form and Instruction	8	Yes	Yes	Fillable Fileable
Form and Instruction	9	Yes	Yes	Fillable Fileable
Form and Instruction	10	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 785

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	785	785
Annual IC Time Burden (Hours)	262	262
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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