Information Collection

PHS Human Subjects and Clinical Trial Information (Part of RPPR, includes inclusion enrollment report)

IC 225112 under ICR 202408-0925-003 · OMB 0925-0002.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 PHS Human Subjects and Clinical Trial Information (Part of RPPR, includes inclusion enrollment report)	Form
Form 1 Form PHS Human Subjects and Clinical Trial Information (Part of RPPR, includes inclusion enrollment report)	Form
Form 2 Form PHS Human Subjects and Clinical Trial Information (Part of RPPR, includes inclusion enrollment report)	Form
Form 3 Form PHS Human Subjects and Clinical Trial Information (Part of RPPR, includes inclusion enrollment report)	Form
1 Form Attachment 5B_HumanSubjectStudy_3_0-V3.0_Sections 1-6.pdf	Form
1 Form Attachment 5B_HumanSubjectStudy_3_0-V3.0_Sections 1-6.pdf	Form
2 Form Attachment 5B_PHSHumanSubjectsAndClinicalTrialsInfo_3_0-V3.0.pdf	Form
2 Form Attachment 5B_PHSHumanSubjectsAndClinicalTrialsInfo_3_0-V3.0.pdf	Form
3 Form Attachment 5B_PHSInclusionEnrollmentReport-V1.0.pdf	Form
3 Form Attachment 5B_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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Yes	Yes	Fillable Fileable
Form	2	Yes	Yes	Fillable Fileable
Form	3	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,420

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	6,420	6,420
Annual IC Time Burden (Hours)	25,680	25,680
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.

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