Notification of Incarcerated Participant Form (Attachment B49)

CTEP Branch Support Contracts Forms and Surveys (NCI)

Documents and Forms

Document Name Document Type
Form 97 Notification of Incarcerated Participant Form (Attachment B49) Form and Instruction
97 Attachment B49 Incarcerated Participant Wrksht Attachment_B49_Incarcerated_Participant_Wrksht.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Notification of Incarcerated Participant Form (Attachment B49)	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 and Instruction	97	Attachment B49 Incarcerated Participant Wrksht	Attachment_B49_Incarcerated_Participant_Wrksht.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0200, “Clinical Basic and Population-based Research Studies of the NIH/HHS/OD	FR Citation: 67 FR 60742

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.