Information Collection

Inclusion Enrollment Form

IC 248482 under ICR 202409-0925-006 · OMB 0925-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0770 can be found here:

2024-11-27 - RCF Recertification

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Inclusion Enrollment Form	Form
Attachment 2B_Inclusion Enrollment Report Instructions_Competing and noncompeting_FORMS-I.docx	Instruction
Attachment 2B_Inclusion Enrollment Report Instructions_Competing and noncompeting_FORMS-I.docx	Instruction
1 Form Attachment 2A_PHSInclusionEnrollmentReport.pdf	Form
1 Form Attachment 2A_PHSInclusionEnrollmentReport.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Inclusion Enrollment Form

Agency IC Tracking Number:

Is this a Common Form? Yes

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Form	Attachment 2A_PHSInclusionEnrollmentReport.pdf		Yes	Yes	Fillable Fileable
Instruction			Attachment 2B_Inclusion Enrollment Report Instructions_Competing and noncompeting_FORMS-I.docx		Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: NIH 09-25-0036, Extramural Awards and Chartered Advisory Committees (IMPAC 2), Contract Information (DCIS), and Cooperative Agreement Information, HHS/NIH

FR Citation: 67 FR 60742

Number of Respondents: 69,888

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	69,888	2,000	67,888
Annual IC Time Burden (Hours)	69,888	2,000	67,888
Annual IC Cost Burden (Dollars)	0	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.