Information Collection

Statement of Investigator (Attachment 3A, 3B or 10)

IC 190375 under ICR 201302-0925-005 · OMB 0925-0613.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0613 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Statement of Investigator (Attachment 3A, 3B or 10)	Form and Instruction
1 Statement of Investigator CTEP Attach_3A_Statement of Investigator_CTEP.pdf	Form and Instruction
2 Statement of Investigator DCP Attach_3B_Statement of Investigator_DCP.pdf	Form and Instruction
3 Statement of Investigator Online Attach_10_NCI OCR Screen Shots.pdf	Form

IC Title:

Statement of Investigator (Attachment 3A, 3B or 10)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	1	Statement of Investigator CTEP	Attach_3A_Statement of Investigator_CTEP.pdf	No	No	Printable Only
Form and Instruction	2	Statement of Investigator DCP	Attach_3B_Statement of Investigator_DCP.pdf	Yes	Yes	Fillable Fileable
Form	3	Statement of Investigator Online	Attach_10_NCI OCR Screen Shots.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: , 09-25-0200, "Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH) HHS/NIH/OD"

FR Citation: 67 FR 60776

Number of Respondents: 20,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20,200	3,072	17,128
Annual IC Time Burden (Hours)	5,050	768	4,282
Annual IC Cost Burden (Dollars)	0	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.