Information Collection

CTSU System Access Request Form (Attachment A17)

IC 225870 under ICR 201809-0925-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 17 CTSU System Access Request Form (Attachment A17) Form and Instruction
17 System Access Request Form Attachment_A17_CSARF_072018.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CTSU System Access Request Form (Attachment A17)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	17	System Access Request Form	Attachment_A17_CSARF_072018.pdf		No		Paper Only

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: 180	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	180	180
Annual IC Time Burden (Hours)	60	60
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.