Information Collection

Device Return

IC 210866 under ICR 201403-0925-008 · OMB 0925-0696.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Device Return	Form and Instruction
1 Device Training Attachment 1 National Heart Lung and Blood Institute Protocol 13-H-0183.docx	Form and Instruction

IC Title:

Device Return

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	1	Device Training	Attachment 1 National Heart Lung and Blood Institute Protocol 13-H-0183.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	5	5
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.