Information Collection

Reference Letter

IC 237527 under ICR 201908-0925-007 · OMB 0925-0763.

Documents and Forms

Document Name Document Type
Form 2 Reference Letter Form
2 Reference letter Att2-Reference Letter Module.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reference Letter	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	2	Reference letter	Att2-Reference Letter Module.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: #09-25-0014, âClinical Research; Student Records, HHS/PHS/NIH/OD/OID/OEâ	FR Citation: 67 FR 60742

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	120	120
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.