Information Collection

Private sector

IC 252166 under ICR 202411-0925-002 · OMB 0925-0689.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0689 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Private sector	Form and Instruction
Form 1 Certification of Confidentiality Private sector	Form and Instruction
Form 2 Assurance Statement Private sector	Form
1 Certification of Confidentiality Attachment 1 - Certificate of Confidentiality Request.pdf	Form and Instruction
1 Certification of Confidentiality Attachment 1 - Certificate of Confidentiality Request.pdf	Form and Instruction
2 Assurance Statement Attachment 1 Update assurance statement NOV 2024. clean.docx	Form
2 Assurance Statement Attachment 1 Update assurance statement NOV 2024. clean.docx	Form

IC Title:

Private sector

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	1				Yes	Yes	Fillable Fileable
Form	2				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0225, NIH Electronic Research Administration (eRA) Records, HHS/NIH/OD/OER

FR Citation: 67 FR 67042

Number of Respondents: 795

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	795	795
Annual IC Time Burden (Hours)	1,193	1,193
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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