Information Collection

eIDP

IC 249045 under ICR 202505-0925-001 · OMB 0925-0772.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 eIDP	Form
Form 1 Application eIDP	Form
Change Request Memo eIDP.docx	Other-Revised Demographic Questions
Change Request Memo eIDP.docx	Other-Revised Demographic Questions
1 Application Data Collection Instrument - eIDP.docx	Form
1 Application Data Collection Instrument - eIDP.docx	Form

IC Title:

eIDP

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	1				Yes	Yes	Fillable Fileable
Other-Revised Demographic Questions					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09â25â0014, âClinical Research; Student Records, HHS/PHS/NIH/OD/OIR/OE.â

FR Citation: 67 FR 67042

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	150	150
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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