Information Collection

NCI/DCTD/CTEP Agent Shipment Form (ASF) (Attachment E04)

IC 230005 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 94 NCI/DCTD/CTEP Agent Shipment Form (ASF) (Attachment E04)	Form and Instruction
Form 94 NCI/DCTD/CTEP Agent Shipment Form (ASF) (Attachment E04)	Form and Instruction
94 Shipment Form (ASF) PMB_Attachment_E04_CTEP_Agent_Ship.pdf	Form and Instruction
94 Shipment Form (ASF) PMB_Attachment_E04_CTEP_Agent_Ship.pdf	Form and Instruction

IC Title:

NCI/DCTD/CTEP Agent Shipment Form (ASF) (Attachment E04)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	94	Shipment Form (ASF)	PMB_Attachment_E04_CTEP_Agent_Ship.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: 24,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	24,000	24,000
Annual IC Time Burden (Hours)	4,000	4,000
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.