Information Collection

Subpart C Research Certification Form

IC 241337 under ICR 202004-0990-004 · OMB 0990-0473.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0473 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Subpart C Certification Form_New ICR_04.14.2020.pdf	Other-Certifcation Form

IC Title:

Subpart C Research Certification Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Other-Certifcation Form			Subpart C Certification Form_New ICR_04.14.2020.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	80	80
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.