Proposed- Cumulative Inclusion Enrollment Report

Cumulative Inclusion Enrollment Report OMB Number: 0925-0001/0002

This report format should NOT be used for collecting data from study participants.

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Racial Categories	Ethnic Categories									Total
	Not Hispanic or Latino			Hispanic or Latino			Unknown/Not Reported Ethnicity
	Female	Male	Unknown/Not Reported	Female	Male	Unknown/ Not Reported	Female	Male	Unknown/Not Reported
American Indian/ Alaska Native	0	0	0	0	0	0	0	0	0	0
Asian	0	0	0	0	0	0	0	0	0	0
Native Hawaiian or Other Pacific Islander	0	0	0	0	0	0	0	0	0	0
Black or African American	0	0	0	0	0	0	0	0	0	0
White	0	0	0	0	0	0	0	0	0	0
More Than One Race	0	0	0	0	0	0	0	0	0	0
Unknown or Not Reported	0	0	0	0	0	0	0	0	0	0
Total	0	0	0	0	0	0	0	0	0	0

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