Information Collection

Study-Specific worksheet About Local Context (Attachment B42)

IC 225914 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 58 Study-Specific worksheet About Local Context (Attachment B42) Form and Instruction
58 SSW Worksheet att_B42 - SSW_Worksheet_022017.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Study-Specific worksheet About Local Context (Attachment B42)	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	58	SSW Worksheet	att_B42 - SSW_Worksheet_022017.pdf		Yes	Yes	Fillable Fileable

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: 4,800	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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,800	4,800
Annual IC Time Burden (Hours)	1,600	1,600
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.