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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

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.