Chimpanzee Research Use Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 CRU Form Sample with screen shots	Form and Instruction	Modified	Available
0925-0705 Change Request Memo to OMB (1).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2016-05-31	Available
Attach 5_NOT-OD-12-116 Clarification to the Interim Agency Policy.mht	Supplementary Document	Uploaded 2014-08-06	Repair queued
Attach 4_Announcement of NIH Decision.pdf	Supplementary Document	Uploaded 2014-08-06	Repair queued
Attach 3_WORKING GROUP REPORT.pdf	Supplementary Document	Uploaded 2014-08-06	Available
Attach 2_NIH Guide Notice NOT-OD-12-025.pdf	Supplementary Document	Uploaded 2014-08-06	Available
Attach 1_IOM Report.pdf	Supplementary Document	Uploaded 2014-08-06	Available
REVISED Support_stmt_A for ChimpanzeeResearch 09032014.doc	Supporting Statement A	Uploaded 2014-09-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212595	CRU Form Sample with screen shots	Form and Instruction	Modified

ICR Details

OMB Control No: 0925-0705	ICR Reference No: 201605-0925-010
Status: Historical Active	Previous ICR Reference No: 201408-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Chimpanzee Research Use Form
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/31/2016
	Date Received in OIRA: 05/31/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	10/31/2017	10/31/2017
Responses	20	0	20
Time Burden (Hours)	10	0	40
Cost Burden (Dollars)	0	0	0

---

Abstract: The purpose of this form is to obtain information needed by the National Institutes of Health (NIH) to assess whether the proposed research triggers consideration by the Chimpanzee Research Use Panel (CRUP) and the NIH Council of Councils (Council), and if so, whether the research satisfies the interim agency policy for research involving chimpanzees

---

Authorizing Statute(s): US Code: 42 USC Chapter 6A, Subchapter II, Name of Law: Research and Investigations
  

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:
	79 FR 27318	05/13/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 161	08/20/2014
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CRU Form Sample with screen shots	1, 1	CRU Form ,   Revised CRU 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	20	20	0	0	0	0
Annual Time Burden (Hours)	10	40	0	-30	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

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

Burden Reduction Due to: Changing Forms

Short Statement: The NIH plans to simplify the information collection by removing obsolete sections and update language to conform to the Federal Register and NIH Guide notices. Based on previous testing using the portion of the information collection instrument that is still applicable, the burden is reduced from 2 hours to 30 minutes.

---

Annual Cost to Federal Government: $44,408

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: 05/31/2016

---