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 Cooperative Group Response to CIRB Review (Attachment B27) New 30 30 0 Form and Instruction 43
Adult Expedited Amendment Review (Attachment B23) New 348 174 0 Form and Instruction 39
Adult Expedited Continuing Review (Attachment B25) New 140 70 0 Form and Instruction 41
Adult Expedited Study Chair Response to Required Mod (Attachment B29) New 40 10 0 Form and Instruction 45
Adult IR of cooperative Group Protocol (Attachment B15) New 65 195 0 Form and Instruction 31
Adult amendment of Cooperative Group Protocol (Attachment B19) New 40 80 0 Form and Instruction 35
Annual Principal Investigator Worksheet About Local Context (Attachment B41) New 1800 600 0 Form and Instruction 57
Annual signatory Institution Worksheet About Local Context (Attachment B40) New 400 267 0 Form and Instruction 56
CIRB Amendment Review Application (Attachment B12) New 400 100 0 Form and Instruction 28
CIRB Ancillary Studies Application (Attachment B13) New 1 1 0 Form and Instruction 29
CIRB Application for Translated Documents (Attachment B33) New 100 50 0 Form and Instruction 49
CIRB Board Member NDA (Attachment B6) New 25 4 0 Form and Instruction 22
CIRB Board member Annual Assessment Survey (Attachment C7) New 60 20 0 Form 71
CIRB Board member Biographical Sketch (Attachment B3) New 25 6 0 Form and Instruction 20
CIRB Board member Contact Information Form (Attachment B4) New 25 4 0 Form and Instruction 21
CIRB COI Screening for CIRB meetings (Attachment B9) New 72 18 0 Form and Instruction 25
CIRB Continuing Review Application (Attachment B14) New 400 200 0 Form and Instruction 30
CIRB Customer Satisfaction survey (Attachment C4) New 600 150 0 Form 65
CIRB Direct Deposit Form (Attachment B7) New 25 6 0 Form 23
CIRB IR Application (Attachment B10) New 80 80 0 Form and Instruction 26
CIRB IR Application for Exempt Studies (Attachment B11) New 4 2 0 Form and Instruction 27
CIRB Member COI Screening Worksheet (Attachment B8) New 12 6 0 Form and Instruction 24
CPC Pharmacist's Review of Cooperative Group Study (Attachment B22) New 20 40 0 Form and Instruction 38
CTSU Generic Data transmittal form (Attachment A12) New 60 10 0 Form and Instruction 12
CTSU Help Desk Customer Satisfaction Survey (Attachment C2) New 325 81 0 Form and Instruction 63
CTSU IRB Certification Form (Attachment A2) New 29328 4888 0 Form and Instruction 2
CTSU IRB/Regulatory Approval Transmittal Form (Attachment A1) New 29328 978 0 Form and Instruction 1
CTSU OPEN Survey (Attachment C3) New 60 15 0 Form 64
CTSU Patient Enrollment Transmittal Form (Attachment A15) New 144 24 0 Form and Instruction 15
CTSU Request for Clinical Brochure (Attachment A6) New 360 60 0 Form and Instruction 6
CTSU Roster Update Form (Attachment A5) New 600 50 0 Form and Instruction 5
CTSU Supply Request Form (Attachment A7) New 1080 180 0 Form and Instruction 7
CTSU System Access Request Form (Attachment A17) New 180 60 0 Form and Instruction 17
CTSU Transfer Form (Attachment A16) New 720 120 0 Form and Instruction 16
CTSU Website Customer Satisfaction Survey (Attachment C1) New 275 69 0 Form 62
Change of SI PI Form (Attachment B45) New 120 30 0 Form and Instruction 61
Concept Clinical Trial Survey (Attachment C9) New 500 42 0 Form 73
Data Clarification Form (Attachment A9) New 3600 600 0 Form and Instruction 9
ETCTN PI Survey (Attachment C12) New 75 19 0 Form 76
ETCTN RS Survey (Attachment C13) New 175 44 0 Form 77
Follow-up survey (Communication Audit) (Attachment C5) New 300 75 0 Form 66
Low Accural clinical Trial Survey (Attachment C11) New 1000 17 0 Form 75
MC0845 (8233) CTSU Data Transmittal Form (Attachment A11) New 60 10 0 Form and Instruction 11
NCI CIRB AA & DOR between the NCI CIRB and Signatory Institution (Attachment B1) New 50 13 0 Form and Instruction 18
NCI CIRB Signatory Enrollment Form (Attachment B2) New 50 13 0 Form and Instruction 19
PIO Customer Satisfaction Survey (Attachment C8) New 60 5 0 Form 72
Pediatric Amendment of Cooperative Group Protocol (Attachment B20) New 25 50 0 Form and Instruction 36
Pediatric Continuing Review of Cooperative Group Protocol (Attachment B18) New 130 130 0 Form and Instruction 34
Pediatric Cooperative Group Response to CIRB Review (Attachment B28) New 5 5 0 Form and Instruction 44
Pediatric Expedited Amendment Review (Attachment B24) New 140 70 0 Form and Instruction 40
Pediatric Expedited Continuing Review (Attachment B26) New 36 18 0 Form and Instruction 42
Pediatric Expedited Strudy Chair Response to Required Mod (Attachment B30) New 40 10 0 Form and Instruction 46
Pediatric IR of Cooperative Group Protocol (Attachment B16) New 15 45 0 Form and Instruction 32
Pharmacist's Review of a Cooperative Group Study (Attachment B21) New 10 20 0 Form and Instruction 37
Prospective Clinical Trial Survey (Attachment C10) New 1000 17 0 Form 74
RTOG 0834 CTSU Data Transmittal Form (Attachment A10) New 912 152 0 Form and Instruction 10
Reviewer Worksheet CPC - Determination of UP or SCN (Attachment B39) New 40 10 0 Form and Instruction 55
Reviewer Worksheet Determination of UP or SCN (Attachment B31) New 360 60 0 Form and Instruction 47
Reviewer Worksheet expedited Review of Study Chair Response to CIRB-Required Modifications (Attachment B37) New 5 3 0 Form and Instruction 53
Reviewer Worksheet of Expedited IR (Attachment B38) New 5 3 0 Form and Instruction 54
Reviewer Worksheet of Recruitment Material (Attachment B35) New 20 5 0 Form and Instruction 51
Reviewer Worksheet of Translated Documents (Attachment B34) New 100 25 0 Form and Instruction 50
Reviewer worksheet CIRB Statistical Reviewer Form (Attachment B32) New 100 100 0 Form and Instruction 48
Reviewer worksheet Expedited Study Closure Review (Attachment B36) New 20 5 0 Form and Instruction 52
Site Addition Form (Attachment A4) New 960 160 0 Form and Instruction 4
Site Initated Data Update Form (Attachment A8) New 24 4 0 Form and Instruction 8
Study Closure or Transfer of Study Review Responsibility Form (Attachment B43) New 1680 420 0 Form and Instruction 59
Study-Specific worksheet About Local Context (Attachment B42) New 4800 1600 0 Form and Instruction 58
TAILORx_PACCT1_Data Transmittal Form (Attachment A13) New 15456 2576 0 Form and Instruction 13
UP or SCN Reporting Form (Attachment B44) New 360 120 0 Form and Instruction 60
Uncolicited Data Modification Form: Protocol: TAILORx/PACCT-1 (Attachment A14) New 360 60 0 Form and Instruction 14
Website Focus Groups, Communication Project (Attachments C6 A-D) New 18 18 0 Form 67
Form 68
Form 69
Form 70
Withdrawl from Protocol Participation Form (Attachment A3) New 279 47 0 Form and Instruction 3
Total burden requested under this ICR: 100337 15524 0  
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