Request Waiver of Assent Form (Attachment B46)

CTEP Branch Support Contracts Forms and Surveys (NCI)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 83 Request Waiver of Assent Form (Attachment B46) Form
83 Waiver Assent Worksheet B46_Waiver_Assent_Worksheet_11062017.pdf Form
83 Waiver Assent Worksheet B46_Waiver_Assent_Worksheet_11062017.pdf Form

Information Collection (IC) Details

IC Title:	Request Waiver of Assent Form (Attachment B46)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	83	Waiver Assent Worksheet	B46_Waiver_Assent_Worksheet_11062017.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research of the National Institutes of Health (NIH)	FR Citation: 67 FR 60742

Number of Respondents: 35	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	Previously Approved
Annual Number of Responses for this IC	35	-25	60
Annual IC Time Burden (Hours)	12	-8	20
Annual IC Cost Burden (Dollars)	0	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.