Information Collection

398/424 PHS Human Subjects and Clinical Trial Information

IC 225108 under ICR 202408-0925-001 · OMB 0925-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 398/424 PHS Human Subjects and Clinical Trial Information	Form
Attachment 5G_PHS HSCT Form_Instructions_FORMS-I.docx	Instruction
Attachment 5G_PHS HSCT Form_Instructions_FORMS-I.docx	Instruction
1 Form Attachment 5F_HumanSubjectStudy_3_0-V3.0_Sections 1-6.pdf	Form
1 Form Attachment 5F_HumanSubjectStudy_3_0-V3.0_Sections 1-6.pdf	Form
2 Form Attachment 5F_PHSHumanSubjectsAndClinicalTrialsInfo_3_0-V3.0.pdf	Form
2 Form Attachment 5F_PHSHumanSubjectsAndClinicalTrialsInfo_3_0-V3.0.pdf	Form
3 Form Attachment 5F_PHSInclusionEnrollmentReport-V1.0.pdf	Form
3 Form Attachment 5F_PHSInclusionEnrollmentReport-V1.0.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Form	Attachment 5F_HumanSubjectStudy_3_0-V3.0_Sections 1-6.pdf	Yes	Yes	Fillable Fileable
Form	2	Form	Attachment 5F_PHSHumanSubjectsAndClinicalTrialsInfo_3_0-V3.0.pdf	Yes	Yes	Fillable Fileable
Form	3	Form	Attachment 5F_PHSInclusionEnrollmentReport-V1.0.pdf	Yes	Yes	Fillable Fileable
Instruction			Attachment 5G_PHS HSCT Form_Instructions_FORMS-I.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54,838

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	Previously Approved
Annual Number of Responses for this IC	54,838	54,838
Annual IC Time Burden (Hours)	712,894	712,894
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.