Information Collection

Attach 1Q - Z1041 CTSU Data Transmittal Form

IC 195169 under ICR 201312-0925-003 · OMB 0925-0624.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0624 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 17 Attach 1Q - Z1041 CTSU Data Transmittal Form	Form and Instruction
17 Attach 1Q - Z1041 CTSU Data Transmittal Form attach_1q_1041dtf.zip	Form and Instruction

IC Title:

Attach 1Q - Z1041 CTSU Data Transmittal Form

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	17	Attach 1Q - Z1041 CTSU Data Transmittal Form	attach_1q_1041dtf.zip		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH), HHS/NIH/OD

FR Citation: 67 FR 60776

Number of Respondents: 50

Number of Respondents for Small Entity: 16

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-600	600
Annual IC Time Burden (Hours)	-100	100
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.