Information Collection

Attach 1Q - CTSU Transfer Form

IC 195181 under ICR 201604-0925-004 · OMB 0925-0624.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 17 Attach 1Q - CTSU Transfer Form	Form and Instruction
17 Attachment 1q CTSU Request for Patient Transfer Attahcment 1q ENR 61 02 04 e1v2.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	17	Attachment 1q CTSU Request for Patient Transfer	Attahcment 1q ENR 61 02 04 e1v2.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH), HHS/NIH/OD

FR Citation: 67 FR 60776

Number of Respondents: 20

Number of Respondents for Small Entity: 6

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	40	40
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.