Information Collection

NCI/DCTD/CTEP Financial Disclosure Form (Attachment E03)

IC 230004 under ICR 202411-0925-001 · OMB 0925-0753.

Documents and Forms

Document Name Document Type
Form 1 NCI/DCTD/CTEP Financial Disclosure Form (Attachment E03) Form
1 Financial Disclosure PMB_Attachment_E03_FDF.pdf Form
1 Financial Disclosure PMB_Attachment_E03_FDF.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NCI/DCTD/CTEP Financial Disclosure Form (Attachment E03)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Financial Disclosure	PMB_Attachment_E03_FDF.pdf		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: 48,000	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	48,000	48,000
Annual IC Time Burden (Hours)	12,000	12,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.