Information Collection

CIRB Ancillary Studies Application (Attachment B13)

IC 225883 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 29 CIRB Ancillary Studies Application (Attachment B13)	Form and Instruction
29 CIRB Ancillary Application att_B13 - CIRB_ Ancillary Application 082505_Update_021911.pdf	Form and Instruction

IC Title:

CIRB Ancillary Studies Application (Attachment B13)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	29	CIRB Ancillary Application	att_B13 - CIRB_ Ancillary Application 082505_Update_021911.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: c

FR Citation: 67 FR 60742

Number of Respondents: 1

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: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
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
No associated records found

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