Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Continuing Review of Cooperative Group Protocol (Attachment B17) Unchanged 275 275 0 Form and Instruction 33
Adult Cooperative Group Response to CIRB Review (Attachment B27) Unchanged 30 30 0 Form and Instruction 43
Adult Expedited Amendment Review (Attachment B23) Unchanged 348 174 0 Form and Instruction 39
Adult Expedited Continuing Review (Attachment B25) Unchanged 140 70 0 Form and Instruction 41
Adult Expedited Study Chair Response to Required Mod (Attachment B29) Unchanged 40 20 0 Form 45
Adult IR of cooperative Group Protocol (Attachment B15) Unchanged 65 195 0 Form and Instruction 31
Adult amendment of Cooperative Group Protocol (Attachment B19) Unchanged 40 80 0 Form and Instruction 35
Annual Principal Investigator Worksheet About Local Context (Attachment B41) Unchanged 1800 600 0 Form and Instruction 57
Annual signatory Institution Worksheet About Local Context (Attachment B40) Unchanged 400 267 0 Form and Instruction 56
Audit Maintenance Form (Attachment D03) Unchanged 760 114 0 Form 86
Audit Scheduling Form (Attachment D01) Unchanged 760 266 0 Form 84
CIRB Amendment Review Application (Attachment B12) Unchanged 400 100 0 Form and Instruction 28
CIRB Ancillary Studies Application (Attachment B13) Unchanged 1 1 0 Form and Instruction 29
CIRB Application for Translated Documents (Attachment B33) Unchanged 100 50 0 Form and Instruction 49
CIRB Board Member Application (Attachment B3) Unchanged 100 50 0 Form 82
CIRB Board member Annual Assessment Survey (Attachment C7) Unchanged 60 15 0 Form 71
CIRB COI Screening for CIRB meetings (Attachment B9) Unchanged 72 18 0 Form and Instruction 25
CIRB Continuing Review Application (Attachment B14) Unchanged 400 100 0 Form 30
CIRB Customer Satisfaction survey (Attachment C4) Unchanged 600 150 0 Form 65
CIRB IR Application (Attachment B10) Unchanged 80 80 0 Form and Instruction 26
CIRB IR Application for Exempt Studies (Attachment B11) Unchanged 4 2 0 Form and Instruction 27
CIRB Member COI Screening Worksheet (Attachment B8) Unchanged 100 25 0 Form 24
CIRB Waiver of Consent Request Supplemental Form (Attachment B47) Unchanged 20 5 0 Form and Instruction 95
CTSU CLASS Course Setup Form (Attachment A22) Unchanged 20 7 0 Form 99
CTSU IRB Certification Form (Attachment A2) Unchanged 29328 4888 0 Form and Instruction 2
CTSU IRB/Regulatory Approval Transmittal Form (Attachment A1) Unchanged 29328 978 0 Form and Instruction 1
CTSU LPO Form Creation (Attachment A19) Unchanged 10 20 0 Form 79
CTSU OPEN Rave Request Form (Attachment A18) Modified 630 105 0 Form and Instruction 76
CTSU OPEN Survey (Attachment C3) Unchanged 10 3 0 Form 64
CTSU PDF Signature Form (Attachment A21) Unchanged 4000 667 0 Form 81
CTSU Patient Enrollment Transmittal Form (Attachment A15) Unchanged 144 24 0 Form and Instruction 15
CTSU Request for Clinical Brochure (Attachment A6) Unchanged 360 60 0 Form and Instruction 6
CTSU Site Form Creation and PDF (Attachment A20) Unchanged 4000 2000 0 Form 80
CTSU Supply Request Form (Attachment A7) Unchanged 1080 180 0 Form and Instruction 7
CTSU Transfer Form (Attachment A16) Unchanged 720 120 0 Form and Instruction 16
Change of SI PI Form (Attachment B45) Unchanged 120 40 0 Form 61
Final Audit Finding Report Form (Attachment D04) Unchanged 825 15098 0 Form 87
Final Report and CAPA Request Form (Attachment D07) Unchanged 108 3240 0 Form 90
Follow-up Form (Attachment D05) Unchanged 525 236 0 Form 88
Follow-up survey (Communication Audit) (Attachment C5) Unchanged 300 75 0 Form 66
NCI CIRB AA & DOR between the NCI CIRB and Signatory Institution (Attachment B1) Unchanged 50 13 0 Form and Instruction 18
NCI CIRB Signatory Enrollment Form (Attachment B2) Unchanged 50 13 0 Form and Instruction 19
NCI/DCTD/CTEP Agent Shipment Form (ASF) (Attachment E04) Unchanged 24000 4000 0 Form and Instruction 94
NCI/DCTD/CTEP Biosketch (Attachment E02) Unchanged 48000 96000 0 Form and Instruction 92
NCI/DCTD/CTEP FDA Form 1572 for Annual Submission (Attachment E01) Unchanged 26500 6625 0 Form and Instruction 91
NCI/DCTD/CTEP Financial Disclosure Form (Attachment E03) Unchanged 48000 12000 0 Form 1
Notification of Incarcerated Participant Form (Attachment B49) Unchanged 20 7 0 Form and Instruction 97
PIO Customer Satisfaction Survey (Attachment C8) Unchanged 60 5 0 Form 72
Pediatric Amendment of Cooperative Group Protocol (Attachment B20) Unchanged 25 50 0 Form and Instruction 36
Pediatric Cooperative Group Response to CIRB Review (Attachment B28) Unchanged 5 5 0 Form and Instruction 44
Pediatric Expedited Amendment Review (Attachment B24) Unchanged 140 70 0 Form and Instruction 40
Pediatric Expedited Continuing Review (Attachment B26) Unchanged 36 18 0 Form and Instruction 42
Pediatric IR of Cooperative Group Protocol (Attachment B16) Unchanged 15 45 0 Form and Instruction 32
Pharmacist's Review of a Cooperative Group Study (Attachment B21) Unchanged 50 100 0 Form and Instruction 37
Preliminary Audit Findings Form (Attachment D02) Unchanged 760 127 0 Form 85
RTOG 0834 CTSU Data Transmittal Form (Attachment A10) Unchanged 912 152 0 Form and Instruction 10
Request Waiver of Assent Form (Attachment B46) Unchanged 35 12 0 Form 83
Review Worksheet CIRB Review for Inclusion of Incarcerated Participants (Attachment B48) Unchanged 20 20 0 Form and Instruction 96
Reviewer Worksheet Determination of UP or SCN (Attachment B31) Unchanged 400 67 0 Form and Instruction 47
Reviewer Worksheet of Expedited IR (Attachment B38) Unchanged 5 3 0 Form and Instruction 54
Reviewer Worksheet of Recruitment Material (Attachment B35) Unchanged 20 5 0 Form and Instruction 51
Reviewer Worksheet of Translated Documents (Attachment B34) Unchanged 100 25 0 Form and Instruction 50
Reviewer worksheet CIRB Statistical Reviewer Form (Attachment B32) Unchanged 100 25 0 Form 48
Reviewer worksheet Expedited Study Closure Review (Attachment B36) Unchanged 20 5 0 Form and Instruction 52
Roster Maintenance Form (Attachment D06) Unchanged 5 2 0 Form 89
Site Addition Form (Attachment A4) Unchanged 960 160 0 Form and Instruction 4
Study Closure or Transfer of Study Review Responsibility Form (Attachment B43) Unchanged 1680 420 0 Form 59
Study-Specific worksheet About Local Context (Attachment B42) Unchanged 4800 1200 0 Form and Instruction 58
UP or SCN Reporting Form (Attachment B44) Unchanged 360 120 0 Form and Instruction 60
Withdrawl from Protocol Participation Form (Attachment A3) Unchanged 279 47 0 Form and Instruction 3
Total burden requested under this ICR: 235510 151769 0  
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