Information Collection

Direct Deposit Form (Attach 4)

IC 195541 under ICR 201311-0925-004 · OMB 0925-0625.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0625 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Direct Deposit Form (Attach 4) Form and Instruction
4 CIRB Direct Deposit Form 4 - CIRB Direct Deposit Form_CIRB_OMB_PRV_TITLE.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Direct Deposit Form (Attach 4)	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	4	CIRB Direct Deposit Form	4 - CIRB Direct Deposit Form_CIRB_OMB_PRV_TITLE.doc		No	No	Printable Only

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 Natonal Institutes of Health (NIH), HHS/NIH/OD"	FR Citation: 67 FR 60776

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	25	9	16
Annual IC Time Burden (Hours)	6	2	4
Annual IC Cost Burden (Dollars)	0	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.