Information Collection

Clinical Trial Participation Costs Survey

IC 268029 under ICR 202610-0990-015 · OMB 0990-0421.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990-0421 Clinical Trials Participation Cost Survey Clinical Trial Participation Costs Survey	Form
0990-0421 Clinical Trials Participation Cost Survey Attachment_A_clinical_trial_costs_Instrument_May2024_Final.docx	Form
Instructions_Consent Doc _Clinical Trial Participation Survey_May2024_Final.docx Informed Consent and Survey Instructions	IC Document
Generic IC_Clinical_Trial_Costs_SS_B_May-30-2024_Final_V2.docx Background and Justification	IC Document
Attachment_B_Clinical_Trial_Survey_Correspondence_May2024_Final doc.docx Documentation and Description for this IC	IC Document
SURVEY_clinical_trial_costs_Instrument_May2024_Final (004).docx Final Electronic Survey	IC Document

IC Title:

Agency IC Tracking Number:

OS/ASPE

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320.5

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	0990-0421				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Informed Consent and Survey Instructions		05/30/2024
Background and Justification		05/30/2024
Documentation and Description for this IC		05/30/2024
Final Electronic Survey		05/30/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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