Information Collection

Participants Medical History Update

IC 221821 under ICR 201606-0925-004 · OMB 0925-0414.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Participants Medical History Update	Form
1 Medical History Update Medical History Update.pdf	Form

IC Title:

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	1	Medical History Update	Medical History Update.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH)

FR Citation: 67 FR 187

Number of Respondents: 40,203

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40,203	40,203
Annual IC Time Burden (Hours)	4,690	4,690
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.