Investigator Registration and Financial Disclosure for Investigational Trials in Cancer Treatment (NCI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 Attach 4 Supplemental Investigator data form	Form and Instruction	New	Available
Form 2 Attach 3B Statement of Investigator DCP copy	Form and Instruction	New	Available
Form 1 Attach 3A NCI Modified FDA form 1572	Form and Instruction	New	Available
Form 8 Attach 2 DARF Oral agent agent accountability	Form and Instruction	Modified	Available
Form 7 Attach 1 DARF Agent accountability	Form and Instruction	Modified	Available
Form 7 CV	Form and Instruction	Removed	Repair queued
Form 6 Attach 5B Financial Disclosure DCP	Form and Instruction	Modified	Available
Form 5 Attach 5 Financial Disclosure Form	Form and Instruction	Modified	Available
Form 4 Supplemental Investigator Data Form	Form and Instruction	Removed	Available
Form 3 Statement of Investigator Online	Form	Removed	Available
Form 2 Statement of Investigator DCP	Form and Instruction	Removed	Available
Form 1 Statement of Investigator CTEP	Form and Instruction	Removed	Available
30-day FRN2016-02447.pdf	Supplementary Document	Uploaded 2016-02-09	Available
SSA final 2.1.16.docx	Supporting Statement A	Uploaded 2016-02-03	Available
Attach_9 PIA_fy12_q2.pdf	Supplementary Document	Uploaded 2016-02-03	Available
Attach_8_Privacy Act Memo_InvestRegis - Copy.doc	Supplementary Document	Uploaded 2016-02-03	Available
Attach_7_OHSR not needed.pdf	Supplementary Document	Uploaded 2016-02-03	Available
Attach_6_DARF Working Group.doc	Supplementary Document	Uploaded 2016-02-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219968	Supplemental Investigator Data Form (Attachment 4)	Form and Instruction	New	Attach 4 Supplemental Investigator data form
219967	Statement of Investigator Attachments 3A or 3B	Form and Instruction	New	Attach 3B Statement of Investigator DCP copy
219967	Statement of Investigator Attachments 3A or 3B	Form and Instruction	New	Attach 3A NCI Modified FDA form 1572
205830	Drug Accountability Record Form (DARF and DARF-Oral)	Form and Instruction	Modified	Attach 2 DARF Oral agent agent accountability
205830	Drug Accountability Record Form (DARF and DARF-Oral)	Form and Instruction	Modified	Attach 1 DARF Agent accountability
205829	Electronic Curriculum Vitae (Attachment 11)	Form and Instruction	Removed	CV
190377	Financial Disclosure Form (Attachments 5A or 5B)	Form and Instruction	Modified	Attach 5B Financial Disclosure DCP
190377	Financial Disclosure Form (Attachments 5A or 5B)	Form and Instruction	Modified	Attach 5 Financial Disclosure Form
190376	Supplemental Investigator Data Form (Attachment 4)	Form and Instruction	Removed	Supplemental Investigator Data Form
190375	Statement of Investigator (Attachment 3A, 3B or 10)	Form	Removed	Statement of Investigator Online
190375	Statement of Investigator (Attachment 3A, 3B or 10)	Form and Instruction	Removed	Statement of Investigator DCP
190375	Statement of Investigator (Attachment 3A, 3B or 10)	Form and Instruction	Removed	Statement of Investigator CTEP

ICR Details

OMB Control No: 0925-0613	ICR Reference No: 201602-0925-006
Status: Historical Active	Previous ICR Reference No: 201302-0925-005
Agency/Subagency: HHS/NIH	Agency Tracking No: 18857
Title: Investigator Registration and Financial Disclosure for Investigational Trials in Cancer Treatment (NCI)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/24/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/10/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved	03/31/2016
Responses	119,457	0	123,724
Time Burden (Hours)	14,649	0	14,328
Cost Burden (Dollars)	0	0	0

---

Abstract: This information collection is a revision for a 3 year period. The U.S. Food and Drug Administration (FDA) holds the National Cancer Institute (NCI), Division of Cancer Treatment and Diagnosis/Cancer Therapy Evaluation Program (NCI/DCTD/CTEP) and the Division of Cancer Prevention (DCP) responsible, as a sponsor of investigational drug trials, for the collection of information about the clinical investigators who participate in these trials and to assure the FDA that systems for accountability are being maintained by investigators in its clinical trials program. The information collected is used to identify qualified investigators and to facilitate the submission and distribution of important information relative to the investigational drug and the response of the patient to that drug. Investigators are physicians who specialize in the treatment of patients with cancer. Data obtained from the Drug Accountability Record is used to track the dispensing of investigational anticancer agents from receipt from the NCI to dispensing or administration to patients. NCI and/or its auditors use this information for compliance purposes.

---

Authorizing Statute(s): US Code: 21 USC 312.58 Name of Law: Public Health Service Act
   US Code: 21 USC 312.62 Name of Law: Public Health Service Act
   US Code: 21 USC 312.64 Name of Law: Public Health Service Act
   US Code: 21 USC 312.53 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 71815	11/17/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 6876	02/09/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Drug Accountability Record Form (DARF and DARF-Oral)	7, 8	Attach 1 DARF Agent accountability ,   Attach 2 DARF Oral agent agent accountability
Electronic Curriculum Vitae (Attachment 11)	7	CV
Financial Disclosure Form (Attachments 5A or 5B)	6, 5	Attach 5 Financial Disclosure Form ,   Attach 5B Financial Disclosure DCP
Statement of Investigator (Attachment 3A, 3B or 10)	1, 2, 3	Statement of Investigator CTEP ,   Statement of Investigator DCP ,   Statement of Investigator Online
Statement of Investigator Attachments 3A or 3B	1, 2	Attach 3A NCI Modified FDA form 1572 ,   Attach 3B Statement of Investigator DCP copy
Supplemental Investigator Data Form (Attachment 4)	4	Supplemental Investigator Data Form
Supplemental Investigator Data Form (Attachment 4)	3	Attach 4 Supplemental Investigator data form

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	119,457	123,724	0	-4,267	0	0
Annual Time Burden (Hours)	14,649	14,328	0	321	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: revision

---

Annual Cost to Federal Government: $779,732

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/10/2016

---