18 One-Time Query for an Organization_0915-0126

Non-visible Questions
Label

Organization
Description

PDF Name (step) Location

Response Visibility
Input
Trigger
Item

Other

One-Time Query
for an
Organization (1)

Below
Text
Organization Entry
Type

The field is
displayed if the
user selects an
organization
type that
requires a
description.

FDA (Federal
One-Time Query
Food and Drug for an
Administration) Organization (1)

Below
Text
checkbox
Entry
"Does the
subject have
a FDA or
CLIA
identification
number?"

The field is
displayed if the
user selects the
checkbox for
"Does the
subject have a
FDA or CLIA
identification
number?"

Selecting the
checkbox displays
FDA and CLIA text
entry fields.

CLIA (Clinical
Laboratory
Improvement
Act)

Below FDA
text entry

Text
Entry

The field is
displayed if the
user selects the
checkbox for
"Does the
subject have a
FDA or CLIA
identification
number?"

Selecting the
checkbox displays
FDA and CLIA text
entry fields.

After step 1
Subject
Information

Check
boxes

Entity Selection
is only
displayed if the
entity is
authorized to
act as an agent
to query on
behalf of other
entities.

All entities are
listed for which the
user is authorized
to query.

One-Time Query
for an
Organization (1)

Entity Selection One-Time Query
for an
Organization (2)

State Changes
Label

PDF Name

Item Type

Trigger

OMB Number:
0915-0126
Expiration
Date:
mm/dd/yyyy

One-Time
Query for an
Organization

Modal

When the user selects the link the
modal is displayed with the public
burden statement content.

Subjects
Available

One-Time
Query for an
Organization

Table

When the user selects the option to
enroll from their subject database,
the summary table of the subjects
with previously saved subject
information is displayed. The user
select one or more names from the
table, then select continue to enter
payment information.

License
Number

One-Time
Query for an
Organization

Text Entry

The field is disabled if the user selects
the "No/ Not sure" option for "Does
the organization have a license?"