Information Collection

Follow-up Form (Attachment D05)

IC 229999 under ICR 202307-0925-003 · OMB 0925-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0753 can be found here:

Documents and Forms

Document Name Document Type
Form 88 Follow-up Form (Attachment D05) Form
Form 88 Follow-up Form (Attachment D05) Form
88 Follow up CTMBAIS_Attachment_D05_Follow_Up.pdf Form
88 Follow up CTMBAIS_Attachment_D05_Follow_Up.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Follow-up Form (Attachment D05)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	88	Follow up	CTMBAIS_Attachment_D05_Follow_Up.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH)	FR Citation: 67 FR 60742

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	525	525
Annual IC Time Burden (Hours)	236	236
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.