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American Indian Alaska Native Data Use Statement and Progress Report
Data Use Certification for the NIH Brain Development Cohorts (NBDC), (NIDA)
OMB: 0925-0780
IC ID: 262235
OMB.report
HHS/NIH
OMB 0925-0780
ICR 202505-0925-003
IC 262235
( )
Documents and Forms
Document Name
Document Type
Form 1
American Indian Alaska Native Data Use Statement and Progress Report
Form
1 Form
Attachment 2 American Indian Alaska Native Data Use Statement and Progress Report -OMB Control Number 0925-0780.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
American Indian Alaska Native Data Use Statement and Progress Report
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Form
Attachment 2 American Indian Alaska Native Data Use Statement and Progress Report -OMB Control Number 0925-0780.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
200
Annual IC Time Burden (Hours)
200
0
0
0
0
200
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
