Information Collection

Fellowship Electronic PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report)

IC 225109 under ICR 201912-0925-005 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 16 Fellowship Electronic PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report)	Form and Instruction
16 Landing Page Attachment 5F PHS Human Subjects and Clinical Trial Information - Landing Page_FORMS-F (002)-.pdf	Form and Instruction
17 Inclusion Enrollment Report Attachment 5F PHS Human Subjects and Clinical Trial Information - Inclusion Enrollment Report_FORMS-F (2).pdf	Form and Instruction
18 HSCT Sections 1-6 Attachment 5F PHS Human Subjects and Clinical Trial Information - Sections 1-6_Includes Inclusion Enrollment Report_FORMS-F-js e	Form and Instruction

IC Title:

Fellowship Electronic PHS Human Subjects and Clinical Trial Information (includes inclusion enrollment report)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	16	Landing Page	Attachment 5F PHS Human Subjects and Clinical Trial Information - Landing Page_FORMS-F (002)-.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	17	Inclusion Enrollment Report	Attachment 5F PHS Human Subjects and Clinical Trial Information - Inclusion Enrollment Report_FORMS-F (2).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	18	HSCT Sections 1-6	Attachment 5F PHS Human Subjects and Clinical Trial Information - Sections 1-6_Includes Inclusion Enrollment Report_FORMS-F-js edits2 (002).pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,030

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	5,030	5,030
Annual IC Time Burden (Hours)	70,420	70,420
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.