Document
User Registration
ICR 202608-0925-003 · OMB 0925-0744 · Object 173145000.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | User Registration |
| Conversion State | complete |
Extracted Text
uilt from BRICS B Account Request Thank you for your interest in the NICHD Data and Specimen Hub (DASH). Please complete the following actions to request an account. OMB Control Number: 0925-0744 Expiration Date: 07/31/2027 1. Account Management Please fill out the information below for your new account. Fields marked with an asterisk (*) are required. Username Check Availability Username:* Contact Information First Name:* Middle Name: Last Name:* Institutional Email:* - Select One - Affiliated Institution:* Other Affiliated Institution:* - Select One - Institution Type:* Institutional Division: - Select one - ob Title/Position:* J Other Job Title/Position:* treet Line 1:* Provide Institution Address S treet Line 2: S City:* Country:* ostal Code:* P tate:* S hone Number: P Continue Cancel Public reporting burden for this collection of information is estimated to average five minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0744). Do not return the completed form to this address. Contact Us NICHD DASH Home Privacy Policy Accessibility Disclaimer FOIA HHS Vulnerability Disclosure