Information Collection

NIAID ClinRegs Country Specific SME Interest Form (NIAID)

IC 243478 under ICR 202109-0925-004 · OMB 0925-0766.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0766 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NIAID ClinRegs Country Specific SME Interest Form (NIAID)	Form
Form 1 NIAID ClinRegs Country Specific SME Interest Form (NIAID)	Form
1 SME Interest form SME-form-with-burden-statement-updated.pdf	Form
1 SME Interest form SME-form-with-burden-statement-updated.pdf	Form
ClinRegs SME Interest Form template.docx sub study request for NIAID ClinRegs SME Interest form	IC Document
ClinRegs SME Interest Form template.docx sub study request for NIAID ClinRegs SME Interest form	IC Document
NIAID ClinRegs SORN.pdf Privacy Act Memo	IC Document
NIAID ClinRegs SORN.pdf Privacy Act Memo	IC Document
NIAID ClinRegs_PIA (1).docx PIA	IC Document
NIAID ClinRegs_PIA (1).docx PIA	IC Document

IC Title:

NIAID ClinRegs Country Specific SME Interest Form (NIAID)

Agency IC Tracking Number:

IC Status: Unchanged

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	1	SME Interest form	SME-form-with-burden-statement-updated.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-90-1802, âHHS Correspondence, Customer Service, and Contact List Records.

FR Citation: 69 FR 71414

Number of Respondents: 50

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 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
sub study request for NIAID ClinRegs SME Interest form	ClinRegs SME Interest Form template.docx	09/03/2020
Privacy Act Memo	NIAID ClinRegs SORN.pdf	09/03/2020
PIA	NIAID ClinRegs_PIA (1).docx	09/03/2020

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