Supplemental Investigator Data Form (Attachment 4)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0613 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Supplemental Investigator Data Form (Attachment 4) Form and Instruction
4 Supplemental Investigator Data Form Attach_4_Supplemental_Investigator_Data_Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Supplemental Investigator Data Form (Attachment 4)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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	4	Supplemental Investigator Data Form	Attach_4_Supplemental_Investigator_Data_Form.pdf		No	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: SORN #09-25-0200, "Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH) HHS/NIH/OD"	FR Citation: 67 FR 60776

Number of Respondents: 20,112	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-20,112	20,112
Annual IC Time Burden (Hours)	-3,352	3,352
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.