Information Collection

NMRI Evaluation Form Day 1

IC 238837 under ICR 202305-0925-005 · OMB 0925-0748.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0748 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NMRI Evaluation Form Day 1	Form and Instruction
1 Evaluation Form (6) NMRI Evaluation form Day 1.pdf	Form and Instruction
1 Evaluation Form (6) NMRI Evaluation form Day 1.pdf	Form and Instruction

IC Title:

NMRI Evaluation Form Day 1

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	Evaluation Form	(6) NMRI Evaluation form Day 1.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: NIH Privacy Act Systems of Record 09-25-0014, âClinical Research: Student Records, HHS/NIH/OD/OIR/OE,â

FR Citation: 67 FR 60742

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	120	0	120
Annual IC Time Burden (Hours)	20	-40	60
Annual IC Cost Burden (Dollars)	0	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.