Information Collection

Reference Letter

IC 233551 under ICR 201911-0925-001 · OMB 0925-0758.

Documents and Forms

Document Name Document Type
Form 4 Reference Letter Form
4 Request for Reference iCURE Program Attach4-Request for Reference _ iCURE Program_6222018.pdf Form
Attach6-Burden Statement.pdf Burden Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reference Letter	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	4	Request for Reference iCURE Program	Attach4-Request for Reference _ iCURE Program_6222018.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Clinical Research; Student Records, HHS/PHS/NIH/OD/OIR/OE	FR Citation: 67 FR 60742

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

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
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
Burden Statement	Attach6-Burden Statement.pdf	10/16/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.