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Fellowship Electronic PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report)
PHS Applications and Pre-award Related Reporting (OD)
OMB: 0925-0001
IC ID: 225109
OMB.report
HHS/NIH
OMB 0925-0001
ICR 201705-0925-009
IC 225109
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:
2022-10-05 - Revision of a currently approved collection
2022-07-22 - No material or nonsubstantive change to a currently approved collection
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:
Unchanged
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
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
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
5,030
0
0
0
0
5,030
Annual IC Time Burden (Hours)
70,420
0
0
0
0
70,420
Annual IC Cost Burden (Dollars)
0
0
0
0
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.