One Time Study Roll Over Worksheet (Attach 2ZA)

NIH NCI Central Institutional Review Board (CIRB) Initiative (NCI)

Documents and Forms

Document Name Document Type
Form 2ZA One Time Study Roll Over Worksheet (Attach 2ZA) Form and Instruction
2ZA One Time Study Roll Over Worksheet REV 2ZA_One Time Study Rollover Worksheet About Local Context_REV.docx Form and Instruction

Information Collection (IC) Details

IC Title:	One Time Study Roll Over Worksheet (Attach 2ZA)	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	2ZA	One Time Study Roll Over Worksheet REV	2ZA_One Time Study Rollover Worksheet About Local Context_REV.docx		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: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	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.