Information Collection

Amendment

IC 221668 under ICR 201908-0925-008 · OMB 0925-0600.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0600 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Amendment Form and Instruction
4 Attach 3c NCI CTRP Amendment Screenshots Attach_3c_NCI CTRP Amendment Screenshots.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Amendment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	4	Attach 3c NCI CTRP Amendment Screenshots	Attach_3c_NCI CTRP Amendment Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	6,000	6,000
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.