Information Collection

CTSU LPO Form Creation (Attachment A19)

IC 229985 under ICR 202408-0925-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 79 CTSU LPO Form Creation (Attachment A19)	Form
Form 79 Protocol Specific DTL CTSU LPO Form Creation (Attachment A19)	Form
79 Protocol Specific DTL Attachment_A19_Prot_Spec_DTL.pdf	Form
79 Protocol Specific DTL Attachment_A19_Prot_Spec_DTL.pdf	Form

IC Title:

CTSU LPO Form Creation (Attachment A19)

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	79				Yes	Yes	Fillable Fileable

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)

FR Citation: 67 FR 60742

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, 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	10	10
Annual IC Time Burden (Hours)	20	20
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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