Information Collection

Supplemental Investigator Data Form (Attachment 4)

IC 190376 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⚠️ Notice: This information collection may be referencing outdated material.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 4 Supplemental Investigator Data Form (Attachment 4)	Form and Instruction
4 Supplemental Investigator Data Form Attach_4_Supplemental_Investigator_Data_Form.pdf	Form and Instruction

IC Title:

Supplemental Investigator Data Form (Attachment 4)

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Supplemental Investigator Data Form	Attach_4_Supplemental_Investigator_Data_Form.pdf		No	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: SORN #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: 20,112

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20,112	2,984	17,128
Annual IC Time Burden (Hours)	3,352	497	2,855
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.