Withdrawl from Protocol Participation Form (Attachment A3)

CTEP Branch Support Contracts Forms and Surveys (NCI)

⚠️ Notice: This information collection may be referencing outdated material.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 3 Withdrawl from Protocol Participation Form (Attachment A3) Form and Instruction
3 Withdrawal Form Attachment_A03_wd_06152018.pdf Form and Instruction

Information Collection (IC) Details

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
Form and Instruction	3	Withdrawal Form	Attachment_A03_wd_06152018.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: 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

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.