Information Collection

Non-IND/NON-Treatment Registration Form (E05)

IC 265725 under ICR 202411-0925-001 · OMB 0925-0753.

Documents and Forms

Document Name Document Type
Form 1 Non-IND/NON-Treatment Registration Form (E05) Form
1 Non-IND/Non-Treatment Registration Form Attachment E05_NINT-Form_v1.10.0_blank_sansOMB.pdf Form
1 Non-IND/Non-Treatment Registration Form Attachment E05_NINT-Form_v1.10.0_blank_sansOMB.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Non-IND/NON-Treatment Registration Form (E05)	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	Non-IND/Non-Treatment Registration Form	Attachment E05_NINT-Form_v1.10.0_blank_sansOMB.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	1,000	1,000
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.