Information Collection

CIRB Statistical Reviewer Form (Attach 6K)

IC 195557 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⚠️ Notice: This information collection may be referencing outdated material.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 6k CIRB Statistical Reviewer Form (Attach 6K)	Form and Instruction
6k CIRB Statistical Reviewer Form 6K_Stat_FB_Reviewer Form.doc	Form and Instruction

IC Title:

CIRB Statistical Reviewer Form (Attach 6K)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	6k	CIRB Statistical Reviewer Form	6K_Stat_FB_Reviewer Form.doc		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: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	10	20
Annual IC Time Burden (Hours)	15	-25	40
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.