Information Collection

Application waiver Supplemental A Research

IC 10278 under ICR 202307-0990-001 · OMB 0990-0001.

Documents and Forms

Document Name Document Type
Form 426 Application waiver Supplemental A Research Form
0990-0001waiver application.doc Other-form
426 Application 0990-0001_waiver-supplementary_A info.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application waiver Supplemental A Research	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 50.CFR

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	426	Application	0990-0001_waiver-supplementary_A info.doc		No	No	Paper Only
Other-form			0990-0001waiver application.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	56,250	56,250

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.