Information Collection

Notification of Incarcerated Participant Form (Attachment B49)

IC 245475 under ICR 202402-0925-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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	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, âClinical 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 %

table that charts list of burden
	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

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.