Information Collection

Provisional Institutional Certification Institutional Official to Certify

IC 257010 under ICR 202501-0925-001 · OMB 0925-0670.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0670 can be found here:

2026-03-17 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Provisional Institutional certification Institutional Official to Certify Provisional Institutional Certification Institutional Official to Certify	Form and Instruction
2 Provisional Institutional certification Institutional Of Attachment 2 2022 - Institutional Certification updates (1).pptx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Provisional Institutional Certification Institutional Official to Certify

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	2				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

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

FR Citation: 67 FR 60751

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: 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	100	100
Annual IC Time Burden (Hours)	75	75
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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