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Epidemiological Research Request -- Private Entities
Epidemiological Research Request
OMB: 0960-0701
IC ID: 183743
OMB.report
SSA
OMB 0960-0701
ICR 201010-0960-004
IC 183743
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0701 can be found here:
2014-01-09 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Epidemiological Research Review Information, Application and Confidentiality Agreement - Revised Version.pdf
Other-Internet Screens
Epidemiological Research Review Information, Application and Confidentiality Agreement - Current Version.pdf
Current Epidemiological Research Review Internet Screens
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Epidemiological Research Request -- Private Entities
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 401.165
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Internet Screens
Epidemiological Research Review Information, Application and Confidentiality Agreement - Revised Version.pdf
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Science and Innovation
Subfunction:
Scientific and Technological Research and Innovation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
13
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:
100 %
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
13
0
0
0
0
13
Annual IC Time Burden (Hours)
26
0
0
0
0
26
Annual IC Cost Burden (Dollars)
47,645
0
0
47,645
0
0
Documents for IC
Title
Document
Date Uploaded
Current Epidemiological Research Review Internet Screens
Epidemiological Research Review Information, Application and Confidentiality Agreement - Current Version.pdf
01/07/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.