Information Collection

Chimpanzee Research Use Form

IC 212595 under ICR 202305-0925-004 · OMB 0925-0705.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0705 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Chimpanzee Research Use Form	Form and Instruction
1 Use Form Attach 9_CRU Form Sample w screen shots.pdf	Form and Instruction
1 Use Form Attach 9_CRU Form Sample w screen shots.pdf	Form and Instruction

IC Title:

Chimpanzee Research Use Form

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	1	Use Form	Attach 9_CRU Form Sample w screen shots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

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)	10	10
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.