SBIR/STTR Funding Agreement Certification

PHS Applications and Pre-award Related Reporting (OD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0001 can be found here:

Documents and Forms

Document Name Document Type
Form 1 SBIR/STTR Funding Agreement Certification Form and Instruction
1 SBIR Funding Agreement Certification Attachment 16A_SBC SBIR-Funding-Agreement-Certification_5-2022_clean.docx Form and Instruction
1 SBIR Funding Agreement Certification Attachment 16A_SBC SBIR-Funding-Agreement-Certification_5-2022_clean.docx Form and Instruction
2 STTR Funding Agreement Certification Attachment 16B_SBC STTR-Funding-Agreement-Certification_5-2022_clean.docx Form and Instruction
2 STTR Funding Agreement Certification Attachment 16B_SBC STTR-Funding-Agreement-Certification_5-2022_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	SBIR/STTR Funding Agreement Certification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	SBIR Funding Agreement Certification	Attachment 16A_SBC SBIR-Funding-Agreement-Certification_5-2022_clean.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	STTR Funding Agreement Certification	Attachment 16B_SBC STTR-Funding-Agreement-Certification_5-2022_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.