CoC Applicants- State and Local

Electronic Application for NIH Certificates of Confidentialty (CoC E-application System)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0689 can be found here:

Documents and Forms

Document Name Document Type
Form 1 CoC Applicants- State and Local Form and Instruction
1 CoC On-line Application ( Screenshots) NETE_OD_OEP_HumanSubjects_Aug13 (2).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	CoC Applicants- State and Local	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	1	CoC On-line Application ( Screenshots)	NETE_OD_OEP_HumanSubjects_Aug13 (2).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD	FR Citation: 67 FR 60765

Number of Respondents: 450	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-450	450
Annual IC Time Burden (Hours)	-675	675
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.