Information Collection

Agreement Form

IC 212394 under ICR 201711-0925-005 · OMB 0925-0177.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0177 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Agreement Form Form
1 Special Volunteer Agreement Form Attachment 3 Special Volunteer Agreement.doc Form
2 Guest Researchers Agreement Form Attachment 4 Guest Researcher Agreement (2).doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Agreement Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	2	Guest Researchers Agreement Form	Attachment 4 Guest Researcher Agreement (2).doc		Yes	Yes	Paper Only
Form	1	Special Volunteer Agreement Form	Attachment 3 Special Volunteer Agreement.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,660	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,660	1,660
Annual IC Time Burden (Hours)	-138	138
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.