Information Collection

Federalwide Assurance (FWA)

IC 10411 under ICR 201404-0990-003 · OMB 0990-0278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0278 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0278_Form for the Federalwide Assurance.docx	Other-survey
0990-0278_Terms of the Federalwide Assurance.doc Terms of the Federalwide Assurance for The Protection of Human Subjects	IC Document
0990-0278_IRB Authorization Agreement for the Federalwide Assurance _Supplemental Sample.rtf Institutional Review Board (IRB) authorization Agreement	IC Document
0990-0278_Individual Investigator Agreement for the Federalwide Assurance _Supplemental Sample.rtf Indivdual Investigator Agreement	IC Document

IC Title:

Federalwide Assurance (FWA)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 46

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
Other-survey			0990-0278_Form for the Federalwide Assurance.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,050

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	22,100	100	22,000
Annual IC Time Burden (Hours)	11,050	50	11,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Terms of the Federalwide Assurance for The Protection of Human Subjects	0990-0278_Terms of the Federalwide Assurance.doc	05/21/2014
Institutional Review Board (IRB) authorization Agreement	0990-0278_IRB Authorization Agreement for the Federalwide Assurance _Supplemental Sample.rtf	05/21/2014
Indivdual Investigator Agreement	0990-0278_Individual Investigator Agreement for the Federalwide Assurance _Supplemental Sample.rtf	05/21/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.