Information Collection

NCS Vanguard Specimen and Data Request Form

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NCS Vanguard Specimen and Data Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	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 %

	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

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.