Information Collection

DASH - Biospecimen Request Private Sector Survey (NICHD)

IC 237318 under ICR 201711-0925-003 · OMB 0925-0643.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 DASH - Biospecimen Request Private Sector Survey (NICHD)	Form
1 DASH Biospecimen screenshots 0925-0643_substudy_NICHD DASH Biospecimen_Survey Screenshots.docx	Form
0925-0643_substudy_NICHD DASH Biospecimen_2019_Private Sector.docx DASH Biospecimen 2019 sub-study	IC Document

IC Title:

Agency IC Tracking Number:

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	1	DASH Biospecimen screenshots	0925-0643_substudy_NICHD DASH Biospecimen_Survey Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DASH Biospecimen 2019 sub-study	0925-0643_substudy_NICHD DASH Biospecimen_2019_Private Sector.docx	08/12/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.