Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Continuing Review of Cooperative Group Protocol (Attachment B17) New 275 275 0 Form and Instruction 33 Adult CR FB Reviewer Worksheet
Adult Cooperative Group Response to CIRB Review (Attachment B27) New 30 30 0 Form and Instruction 43 Adult & CPC FB SCRWksht
Adult Expedited Amendment Review (Attachment B23) New 348 174 0 Form and Instruction 39 Adult & CPC Expedited Reviewer Worksheet
Adult Expedited Continuing Review (Attachment B25) New 140 70 0 Form and Instruction 41 Adult & CPC Expedited CR Worksheet
Adult Expedited Study Chair Response to Required Mod (Attachment B29) New 40 10 0 Form and Instruction 45 Adult & CPC Exped Chair Resp Req Mods
Adult IR of cooperative Group Protocol (Attachment B15) New 65 195 0 Form and Instruction 31 Adult IR FB Reviewer Worksheet
Adult amendment of Cooperative Group Protocol (Attachment B19) New 40 80 0 Form and Instruction 35 Adult AR FB Reviewer Worksheet
Annual Principal Investigator Worksheet About Local Context (Attachment B41) New 1800 600 0 Form and Instruction 57 Annual PI Worksheet
Annual signatory Institution Worksheet About Local Context (Attachment B40) New 400 267 0 Form and Instruction 56 Annual SI Worksheet
CIRB Amendment Review Application (Attachment B12) New 400 100 0 Form and Instruction 28 CIRB AR Application
CIRB Ancillary Studies Application (Attachment B13) New 1 1 0 Form and Instruction 29 CIRB Ancillary Application
CIRB Application for Translated Documents (Attachment B33) New 100 50 0 Form and Instruction 49 CIRB App for Translated Docs
CIRB Board Member NDA (Attachment B6) New 25 4 0 Form and Instruction 22 CIRB Member NDA
CIRB Board member Annual Assessment Survey (Attachment C7) New 60 20 0 Form 71 Annual CIRB Board Assessment
CIRB Board member Biographical Sketch (Attachment B3) New 25 6 0 Form and Instruction 20 CIRB Biosketch Questions CIRB member
CIRB Board member Contact Information Form (Attachment B4) New 25 4 0 Form and Instruction 21 CIRB ContactInfoForm
CIRB COI Screening for CIRB meetings (Attachment B9) New 72 18 0 Form and Instruction 25 COI Screening
CIRB Continuing Review Application (Attachment B14) New 400 200 0 Form and Instruction 30 CIRB CR Application
CIRB Customer Satisfaction survey (Attachment C4) New 600 150 0 Form 65 CIRB Satisfaction survey
CIRB Direct Deposit Form (Attachment B7) New 25 6 0 Form 23 CIRB Direct Deposit Form
CIRB IR Application (Attachment B10) New 80 80 0 Form and Instruction 26 CIRB IR Application
CIRB IR Application for Exempt Studies (Attachment B11) New 4 2 0 Form and Instruction 27 CIRB IR Exempt Application
CIRB Member COI Screening Worksheet (Attachment B8) New 12 6 0 Form and Instruction 24 COI Screen
CPC Pharmacist's Review of Cooperative Group Study (Attachment B22) New 20 40 0 Form and Instruction 38 CPC FB Pharma Reviewer Worksheet
CTSU Generic Data transmittal form (Attachment A12) New 60 10 0 Form and Instruction 12 Generic Data
CTSU Help Desk Customer Satisfaction Survey (Attachment C2) New 325 81 0 Form and Instruction 63 Help Desk Survey
CTSU IRB Certification Form (Attachment A2) New 29328 4888 0 Form and Instruction 2 IRB Certification
CTSU IRB/Regulatory Approval Transmittal Form (Attachment A1) New 29328 978 0 Form and Instruction 1 IRB Transmittal
CTSU OPEN Survey (Attachment C3) New 60 15 0 Form 64 OPEN survey
CTSU Patient Enrollment Transmittal Form (Attachment A15) New 144 24 0 Form and Instruction 15 Patient Enrollment Transmittal form
CTSU Request for Clinical Brochure (Attachment A6) New 360 60 0 Form and Instruction 6 Clinical Brochure
CTSU Roster Update Form (Attachment A5) New 600 50 0 Form and Instruction 5 Roster Update
CTSU Supply Request Form (Attachment A7) New 1080 180 0 Form and Instruction 7 Supply
CTSU System Access Request Form (Attachment A17) New 180 60 0 Form and Instruction 17 System Access Request form
CTSU Transfer Form (Attachment A16) New 720 120 0 Form and Instruction 16 Transfer
CTSU Website Customer Satisfaction Survey (Attachment C1) New 275 69 0 Form 62 websurvey final
Change of SI PI Form (Attachment B45) New 120 30 0 Form and Instruction 61 Change PI Worksheet
Concept Clinical Trial Survey (Attachment C9) New 500 42 0 Form 73 Concept Survey
Data Clarification Form (Attachment A9) New 3600 600 0 Form and Instruction 9 Data Clarification Form
ETCTN PI Survey (Attachment C12) New 75 19 0 Form 76 ETCTN PI Survey
ETCTN RS Survey (Attachment C13) New 175 44 0 Form 77 ETCTN
Follow-up survey (Communication Audit) (Attachment C5) New 300 75 0 Form 66 CIRB FUP Survey
Low Accural clinical Trial Survey (Attachment C11) New 1000 17 0 Form 75 low accuring survey
MC0845 (8233) CTSU Data Transmittal Form (Attachment A11) New 60 10 0 Form and Instruction 11 8233 Form
NCI CIRB AA & DOR between the NCI CIRB and Signatory Institution (Attachment B1) New 50 13 0 Form and Instruction 18 NCI CIRB AA DivofResps
NCI CIRB Signatory Enrollment Form (Attachment B2) New 50 13 0 Form and Instruction 19 NCI CIRB Signatory Enrollment Form
PIO Customer Satisfaction Survey (Attachment C8) New 60 5 0 Form 72 PIO External Survey
Pediatric Amendment of Cooperative Group Protocol (Attachment B20) New 25 50 0 Form and Instruction 36 Ped AR FB Reviewer Worksheet
Pediatric Continuing Review of Cooperative Group Protocol (Attachment B18) New 130 130 0 Form and Instruction 34 Oed CR FB Reviewer Worksheet
Pediatric Cooperative Group Response to CIRB Review (Attachment B28) New 5 5 0 Form and Instruction 44 Ped FB SCRWksht
Pediatric Expedited Amendment Review (Attachment B24) New 140 70 0 Form and Instruction 40 Ped Expedited Reviewer Worksheet
Pediatric Expedited Continuing Review (Attachment B26) New 36 18 0 Form and Instruction 42 Ped Expedited CR Worksheet
Pediatric Expedited Strudy Chair Response to Required Mod (Attachment B30) New 40 10 0 Form and Instruction 46 Ped Exped Chair Resp Req Mods
Pediatric IR of Cooperative Group Protocol (Attachment B16) New 15 45 0 Form and Instruction 32 Ped IR FB Reviewerworksheet
Pharmacist's Review of a Cooperative Group Study (Attachment B21) New 10 20 0 Form and Instruction 37 Adult Ped FB Pharma Adult Reviewer Worksheet
Prospective Clinical Trial Survey (Attachment C10) New 1000 17 0 Form 74 Prospective Survey
RTOG 0834 CTSU Data Transmittal Form (Attachment A10) New 912 152 0 Form and Instruction 10 RTOG0834
Reviewer Worksheet CPC - Determination of UP or SCN (Attachment B39) New 40 10 0 Form and Instruction 55 Reviewer Worksheet CPC UP FB
Reviewer Worksheet Determination of UP or SCN (Attachment B31) New 360 60 0 Form and Instruction 47 Reviewer Worksheet UP FB
Reviewer Worksheet expedited Review of Study Chair Response to CIRB-Required Modifications (Attachment B37) New 5 3 0 Form and Instruction 53 Reviewer Worksheet SCR ER
Reviewer Worksheet of Expedited IR (Attachment B38) New 5 3 0 Form and Instruction 54 Reviewer Worksheet ER IR
Reviewer Worksheet of Recruitment Material (Attachment B35) New 20 5 0 Form and Instruction 51 Reviewer Worksheet Recruitment materials
Reviewer Worksheet of Translated Documents (Attachment B34) New 100 25 0 Form and Instruction 50 Reviewer Worksheet Translated Docs
Reviewer worksheet CIRB Statistical Reviewer Form (Attachment B32) New 100 100 0 Form and Instruction 48 reviewer Worksheet CIRB Stat
Reviewer worksheet Expedited Study Closure Review (Attachment B36) New 20 5 0 Form and Instruction 52 reviewer Worksheet ER ClosureWksht
Site Addition Form (Attachment A4) New 960 160 0 Form and Instruction 4 Site Addition
Site Initated Data Update Form (Attachment A8) New 24 4 0 Form and Instruction 8 Site Data Update form
Study Closure or Transfer of Study Review Responsibility Form (Attachment B43) New 1680 420 0 Form and Instruction 59 Study Closure Worksheet
Study-Specific worksheet About Local Context (Attachment B42) New 4800 1600 0 Form and Instruction 58 SSW Worksheet
TAILORx_PACCT1_Data Transmittal Form (Attachment A13) New 15456 2576 0 Form and Instruction 13 TAILORx PACCT1_DTF
UP or SCN Reporting Form (Attachment B44) New 360 120 0 Form and Instruction 60 Unanticipated Problem Worksheet
Uncolicited Data Modification Form: Protocol: TAILORx/PACCT-1 (Attachment A14) New 360 60 0 Form and Instruction 14 TAILORx UDM
Website Focus Groups, Communication Project (Attachments C6 A-D) New 18 18 0 Form 67 CIRB Website Focus Group Survey - CIRB Members usability
Form 68 CIRB Website Focus Group Survey - Local Instiutions usability
Form 69 CIRB Website Focus Group Survey - Network Groups usability
Form 70 CIRB Website Focus Group Survey -Web site usability testing
Withdrawl from Protocol Participation Form (Attachment A3) New 279 47 0 Form and Instruction 3 Withdrawl form
Total burden requested under this ICR: 100337 15524 0  
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