Notification of Incarcerated Participant Form (Attachment B49)

CTEP Branch Support Contracts Forms and Surveys (NCI)

⚠️ Notice: This information collection may be referencing outdated material.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 97 Notification of Incarcerated Participant Form (Attachment B49) Form and Instruction
97 Attachment B49 Incarcerated Participant Wrksht Attachment_B49_Incarcerated_Participant_Wrksht.pdf Form and Instruction
97 Attachment B49 Incarcerated Participant Wrksht Attachment_B49_Incarcerated_Participant_Wrksht.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Notification of Incarcerated Participant Form (Attachment B49)	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 and Instruction	97	Attachment B49 Incarcerated Participant Wrksht	Attachment_B49_Incarcerated_Participant_Wrksht.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0200, “Clinical Basic and Population-based Research Studies of the NIH/HHS/OD	FR Citation: 67 FR 60742

Number of Respondents: 20	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	7	7
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.