Information Collection

Agreement Form

IC 212394 under ICR 201407-0925-002 · OMB 0925-0177.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0177 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Agreement Form	Form
1 Special Volunteer Agreement Form Attachment 3 Special Volunteer Agreement.doc	Form
2 Guest Researchers Agreement Form Attachment 4 Guest Researcher Agreement (2).doc	Form

IC Title:

Agreement Form

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	1	Special Volunteer Agreement Form	Attachment 3 Special Volunteer Agreement.doc		Yes	Yes	Paper Only
Form	2	Guest Researchers Agreement Form	Attachment 4 Guest Researcher Agreement (2).doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,660

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,660	1,660
Annual IC Time Burden (Hours)	138	138
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.