Information Collection

TAILORx_PACCT1_Data Transmittal Form (Attachment A13)

IC 225862 under ICR 201702-0925-003 · OMB 0925-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0753 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13 TAILORx_PACCT1_Data Transmittal Form (Attachment A13)	Form and Instruction
13 TAILORx PACCT1_DTF Attachment_A13_TAILORx_PACCT1_DTF.pdf	Form and Instruction

IC Title:

TAILORx_PACCT1_Data Transmittal Form (Attachment A13)

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 and Instruction	13	TAILORx PACCT1_DTF	Attachment_A13_TAILORx_PACCT1_DTF.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Clinical Basic and Population-based Research Studies of the National Institutes of Health

FR Citation: 67 FR 60742

Number of Respondents: 161

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	15,456	15,456
Annual IC Time Burden (Hours)	2,576	2,576
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.