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CIRB Waiver of Consent Request Supplemental Form (Attachment B47)
CTEP Branch Support Contracts Forms and Surveys (NCI)
OMB: 0925-0753
IC ID: 245472
OMB.report
HHS/NIH
OMB 0925-0753
ICR 202012-0925-003
IC 245472
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0753 can be found here:
2024-03-28 - Revision of a currently approved collection
2023-07-14 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 95
CIRB Waiver of Consent Request Supplemental Form (Attachment B47)
Form and Instruction
95 CIRB WoC Supp
Attachment_B47_CIRB_WoC_Supp.pdf
Form and Instruction
95 CIRB WoC Supp
Attachment_B47_CIRB_WoC_Supp.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CIRB Waiver of Consent Request Supplemental Form (Attachment B47)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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 and Instruction
95
CIRB WoC Supp
Attachment_B47_CIRB_WoC_Supp.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
09-25-0200, “Clinical Basic and Population-based Research Studies of the NIH/HHS/OD
FR Citation:
67 FR 60742
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20
0
20
0
0
0
Annual IC Time Burden (Hours)
5
0
5
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.