Chimpanzee Research Use Form (OD)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Use Form	Form and Instruction	Modified	Available
Form 1 Chimpanzee Research Use Form	Form and Instruction	Modified	Repair queued
Attach 8_NIH Notice Noninvasive Only1.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Attach 7_FWS Designation1.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Attach 6_NIH Statement.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Attach 5_NOT-OD-14-024.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Attach 4_Announcement of NIH Decision.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Attach 3_WORKING GROUP REPORT.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Attach 2_NIH Guide Notice NOT-OD-12-025.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Attach 1_IOM Report.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Chimp 30day notice.pdf	Supplementary Document	Uploaded 2023-05-30	Repair queued
Supporting_StatementA_CHIMP.docx	Supporting Statement A	Uploaded 2023-05-30	Repair queued
Privacy Memo OD DPCPSI Chimpanzee Research Use Form CRUF 2023 Signed.pdf	Supplementary Document	Uploaded 2023-05-18	Repair queued
PIA Chimpanzee Research Use Reporting System 5-12-2023 SOP.pdf	Supplementary Document	Uploaded 2023-05-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212595	Chimpanzee Research Use Form	Form and Instruction	Modified	Use Form
212595	Chimpanzee Research Use Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0925-0705	ICR Reference No: 202305-0925-004
Status: Historical Active	Previous ICR Reference No: 202007-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Chimpanzee Research Use Form (OD)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/05/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/31/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	36 Months From Approved	09/30/2023
Responses	20	0	20
Time Burden (Hours)	10	0	10
Cost Burden (Dollars)	0	0	0

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Abstract: The National Institutes of Health (NIH) requests to extend the Chimpanzee Research Use Form (OMB Control No. 0925-0705). The purpose of this form is to obtain information needed by the NIH to assess whether the proposed research satisfies the agency policy for research involving chimpanzees. The NIH considers the information submitted through this form prior to the agency making funding decisions or otherwise allowing the research to begin. Completion of this form is a mandatory step toward receiving NIH support or approval for research involving chimpanzees. This is an extension of a previously approved submission.

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Authorizing Statute(s): US Code: 42 USC Chapter 6A, Subchapter II, Name of Law: Research and Investigations
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 10527	02/21/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 34167	05/26/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Chimpanzee Research Use Form	1	Use Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	20	20	0	0	0	0
Annual Time Burden (Hours)	10	10	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $7,005

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/31/2023

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