Information Collection

Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5B )

IC 195545 under ICR 201402-0925-001 · OMB 0925-0625.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5B Adult/Pediatric CIRB Application - Ancillary Studies (Attach 5B )	Form and Instruction
5B Adult/Pediatric CIRB Application - Ancillary Studies REV 5B_Application_Ancillary Protocol Review_REV.doc	Form and Instruction

IC Title:

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	5B	Adult/Pediatric CIRB Application - Ancillary Studies REV	5B_Application_Ancillary Protocol Review_REV.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: 10

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	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	20	20
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.