Information Collection

National Institutes of Health (NIH) Developer Use Statement (DUS)

IC 273816 under ICR 202307-0925-004 · OMB 0925-0766.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0766 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Developer Submitting DUS National Institutes of Health (NIH) Developer Use Statement (DUS)	Form
Form 2 Institutional Signing Official Certifying DUS National Institutes of Health (NIH) Developer Use Statement (DUS)	Form
Form 3 Developer Submitting Renewal DUS National Institutes of Health (NIH) Developer Use Statement (DUS)	Form
Form 4 Institutional Signing Official Certifying DUS National Institutes of Health (NIH) Developer Use Statement (DUS)	Form
Form 5 Developer Submitting DUS National Institutes of Health (NIH) Developer Use Statement (DUS)	Form
Form 6 Institutional Signing Official Certifying DUS National Institutes of Health (NIH) Developer Use Statement (DUS)	Form
1 Developer Submitting DUS Attachment_1_-_DUS_(2025-01).docx	Form
2 Institutional Signing Official Certifying DUS Attachment_1a_-_DUS_(2025-01)[1].docx	Form
3 Developer Submitting Renewal DUS Attachment_2_-_DUS,_renewal_(2025-01).docx	Form
4 Institutional Signing Official Certifying DUS Attachment_2a_-_DUS,_renewal_(2025-01).docx	Form
5 Developer Submitting DUS Attachment_3_-_DUS,_close-out_(2025-01).docx	Form
6 Institutional Signing Official Certifying DUS Attachment_3a_-_DUS,_close-out_(2025-01).docx	Form
Attachment_4_-_Appendix[1].docx Appendix	IC Document
0925-0776_-_Generic_Regular_Sub-Study_.docx Template	IC Document

IC Title:

National Institutes of Health (NIH) Developer Use Statement (DUS)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Yes	Yes	Fillable Fileable
Form	2	Yes	Yes	Fillable Fileable
Form	3	Yes	Yes	Fillable Fileable
Form	4	Yes	Yes	Fillable Fileable
Form	5	Yes	Yes	Fillable Fileable
Form	6	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Records About Restricted Dataset Requesters

FR Citation: 80 FR 17447

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix		01/22/2025
Template		01/22/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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