Information Collection

CIRB Waiver of Consent Request Supplemental Form (Attachment B47)

IC 245472 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0200, âClinical 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 Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.