Information Collection

Study-Specific worksheet About Local Context (Attachment B42)

IC 225914 under ICR 202012-0925-003 · OMB 0925-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0753 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 58 Study-Specific worksheet About Local Context (Attachment B42)	Form and Instruction
58 SSW Worksheet Attachment_B42_Study_Specific_Worksheet_Clean.pdf	Form and Instruction
58 SSW Worksheet Attachment_B42_Study_Specific_Worksheet_Clean.pdf	Form and Instruction

IC Title:

Study-Specific worksheet About Local Context (Attachment B42)

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	58	SSW Worksheet	Attachment_B42_Study_Specific_Worksheet_Clean.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Clinical Basic and Population-based Research Studies of the National Institutes of Health

FR Citation: 67 FR 60742

Number of Respondents: 4,800

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	Previously Approved
Annual Number of Responses for this IC	4,800	0	4,800
Annual IC Time Burden (Hours)	1,200	-400	1,600
Annual IC Cost Burden (Dollars)	0	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.