Information Collection

CIRB Waiver of Consent Request Supplemental Form (Attachment B47)

IC 245472 under ICR 202208-0925-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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 v17MAY2021.pdf	Form and Instruction
95 CIRB WoC Supp Attachment B47 - CIRB WOC Supp v17MAY2021.pdf	Form and Instruction

IC Title:

CIRB Waiver of Consent Request Supplemental Form (Attachment B47)

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	95	CIRB WoC Supp	Attachment B47 - CIRB WOC Supp v17MAY2021.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 %

table that charts list of burden
	Approved	Previously Approved
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

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.