Information Collection

Fellowship Electronic PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report)

IC 225109 under ICR 201701-0925-003 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Document Name Document Type
Form 16 Fellowship Electronic PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report) Form
16 PHS Human Subjects and Clinical Trial Information - Land Attachment 5F PHS Human Subjects and Clinical Trial Information - Landing Page.pdf Form
17 PHS Human Subjects and Clinical Trial Information - Incl Attachment 5F PHS Human Subjects and Clinical Trial Information - Inclusion Enrollment Report.pdf Form
18 PHS Human Subjects and Clinical Trial Information - Sect Attachment 5F PHS Human Subjects and Clinical Trial Information - Sections 1-5.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Fellowship Electronic PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	16	PHS Human Subjects and Clinical Trial Information - Landing Page	Attachment 5F PHS Human Subjects and Clinical Trial Information - Landing Page.pdf	Yes	Yes	Fillable Fileable
Form	17	PHS Human Subjects and Clinical Trial Information - Inclusion Enrollment Report	Attachment 5F PHS Human Subjects and Clinical Trial Information - Inclusion Enrollment Report.pdf	Yes	Yes	Fillable Fileable
Form	18	PHS Human Subjects and Clinical Trial Information - Sections 1-5	Attachment 5F PHS Human Subjects and Clinical Trial Information - Sections 1-5.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,030	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,030	5,030
Annual IC Time Burden (Hours)	70,420	70,420
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.