Information Collection

NIH Other Transaction Application Form

IC 256274 under ICR 202210-0925-002 · OMB 0925-0001.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NIH Other Transaction Application Form	Form and Instruction
1 Other Transaction Application Form Screenshots Attachment 20A_Other Transaction application form_ASSIST screenshots 0001.pdf	Form and Instruction
1 Other Transaction Application Form Screenshots Attachment 20A_Other Transaction application form_ASSIST screenshots 0001.pdf	Form and Instruction
Attachment 20B_Other Transaction_ASSIST user instruction guide.docx Other Transactions Application Form Instructions	IC Document
Attachment 20B_Other Transaction_ASSIST user instruction guide.docx Other Transactions Application Form Instructions	IC Document

IC Title:

NIH Other Transaction Application Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Other Transaction Application Form Screenshots	Attachment 20A_Other Transaction application form_ASSIST screenshots 0001.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 239

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	239	239
Annual IC Time Burden (Hours)	2,629	2,629
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Other Transactions Application Form Instructions	Attachment 20B_Other Transaction_ASSIST user instruction guide.docx	10/05/2022

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