View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Sub-study #19: Addendum to Pilot Study Proposed New Model for the CIRB Participating Institution	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	19	#19_Attach 19A_19B_CIRB Addendum	#19_Attach 19A_19B_CIRB Addendum.docx		Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD	FR Citation: 67 FR 60743

Number of Respondents: 50	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: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	50	0	0	0	0	0
Annual IC Time Burden (Hours)	30	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
#19_Gen IC Form_Add CIRB Pilot	#19_Gen IC Form_Add CIRB Pilot.docx	10/19/2011
#19_Justif Memo Attach 19C_19D_19E_CIRB Addendum	#19_Justif Memo Attach 19C_19D_19E_CIRB Addendum.docx	10/24/2011

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