Information Collection

Subpart C Research Certification Form

IC 241337 under ICR 202609-0990-002 · OMB 0990-0473.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990-0473 HHS Subpart C Certification Form Subpart C Research Certification Form	Form
0990-0473 HHS Subpart C Certification Form HHS Subpart C Certification Form .pdf oashsps.my.site.com/ohrpwebforms/s/prisoner-web-form	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 46.306(a)(2) 45 CFR 46.305(a) 45 CFR 46 45 CFR 46.305(c)

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	0990-0473			https://oashsps.my.site.com/ohrpwebforms/s/prisoner-web-form	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	85	35	50
Annual IC Time Burden (Hours)	85	35	50
Annual IC Cost Burden (Dollars)	0	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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