Information Collection

Statement of Investigator Attachments 3A or 3B

IC 219967 under ICR 201602-0925-006 · OMB 0925-0613.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Statement of Investigator Attachments 3A or 3B	Form and Instruction
1 Attach 3A NCI Modified FDA form 1572 Attach_3A NCI Modified fda_form_1572_final.pdf	Form and Instruction
2 Attach 3B Statement of Investigator DCP copy Attach_3B_Statement of Investigator_DCP - Copy.pdf	Form and Instruction

IC Title:

Statement of Investigator Attachments 3A or 3B

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	Attach 3A NCI Modified FDA form 1572	Attach_3A NCI Modified fda_form_1572_final.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Attach 3B Statement of Investigator DCP copy	Attach_3B_Statement of Investigator_DCP - Copy.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22,283

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	22,283	22,283
Annual IC Time Burden (Hours)	5,571	5,571
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.