Information Collection

Withdrawl from Protocol Participation Form (Attachment A3)

IC 225844 under ICR 201802-0925-001 · OMB 0925-0753.

⚠️ Notice: This information collection may be referencing outdated material.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

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Information Collection (IC) Details

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IC Title:	Withdrawl from Protocol Participation Form (Attachment A3)	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

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: 279	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	279	279
Annual IC Time Burden (Hours)	47	47
Annual IC Cost Burden (Dollars)	0	0

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