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Biospecimen Request
Data and Specimen Hub (DASH) (NICHD)
OMB: 0925-0744
IC ID: 233987
OMB.report
HHS/NIH
OMB 0925-0744
ICR 202404-0925-001
IC 233987
( )
Documents and Forms
Document Name
Document Type
Form 1
Biospecimen Request
Form
1 Biospecimen Request
Attachment A.2-5_Biospecimen Request_OMB 0925-0744_2024 0215.docx
Form
1 Biospecimen Request
Attachment A.2-5_Biospecimen Request_OMB 0925-0744_2024 0215.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Biospecimen Request
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
1
Biospecimen Request
Attachment A.2-5_Biospecimen Request_OMB 0925-0744_2024 0215.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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), HHS/NIH/OD
FR Citation:
67 FR 60742
Number of Respondents:
4
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
4
0
-32
0
0
36
Annual IC Time Burden (Hours)
4
0
-32
0
0
36
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
