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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Subpart C Certification Form_New ICR_04.14.2020.pdf Other-Certifcation Form

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.