Information Collection

NCI Pediatric CIRB Application (Attach 5B)

IC 195544 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 21 NCI Pediatric CIRB Application (Attach 5B)	Form and Instruction
21 NCI Pediatric CIRB Application Attachment 5B - CIRB_Peds_Appl_ 110110.pdf	Form and Instruction
21a NCI Pediatric CIRB Application Attach 5B - CIRB Peds_Change with Highlights.pdf	Form and Instruction
21a NCI Pediatric CIRB Application Attach 5B - CIRB Peds_NEW.pdf	Form and Instruction

IC Title:

NCI Pediatric CIRB Application (Attach 5B)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

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	21	NCI Pediatric CIRB Application	Attachment 5B - CIRB_Peds_Appl_ 110110.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	21a	NCI Pediatric CIRB Application	Attach 5B - CIRB Peds_Change with Highlights.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	21a	NCI Pediatric CIRB Application	Attach 5B - CIRB Peds_NEW.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 Natonal Institutes of Health (NIH), HHS/NIH/OD"

FR Citation: 67 FR 60776

Number of Respondents: 62

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-62	62
Annual IC Time Burden (Hours)	-124	124
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.