Information Collection

NeuroBioBank Tissue Access Request Form

IC 231996 under ICR 202109-0925-003 · OMB 0925-0723.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0723 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NeuroBioBank Tissue Access Request Form	Form and Instruction
1 NBB Tissue Access Request Form Att 1 - Updated NBB Tissue Access Request Form_09.07.21.pdf	Form and Instruction
1 NBB Tissue Access Request Form Att 1 - Updated NBB Tissue Access Request Form_09.07.21.pdf	Form and Instruction

IC Title:

NeuroBioBank Tissue Access Request Form

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	1	NBB Tissue Access Request Form	Att 1 - Updated NBB Tissue Access Request Form_09.07.21.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Extramural Awards and Chartered Advisory Committees (IMPAC 2), Contract Information (DCIS), and Cooperative Agreement Information, HHS/NIH

FR Citation: 67 FR 60742

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: 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	400	175	225
Annual IC Time Burden (Hours)	100	44	56
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.