Information Collection

NCS Vanguard Specimen and Data Request Form

IC 235418 under ICR 201903-0925-001 · OMB 0925-0760.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 NCS Vanguard Specimen and Data Request Form	Form and Instruction
3 NCS Vanguard Data and Sample Request Form Attachment A.3 NCS Vanguard Data and Sample Request Form_3-7-2019.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	3	NCS Vanguard Data and Sample Request Form	Attachment A.3 NCS Vanguard Data and Sample Request Form_3-7-2019.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD

FR Citation: 67 FR 60742

Number of Respondents: 25

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	25	25
Annual IC Time Burden (Hours)	13	13
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.