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Attach 1Di_CTSU Site Addition Form
Cancer Trials Support Unit (CTSU) Public Use Forms and Customer Satisfaction Surveys (NCI)
OMB: 0925-0624
IC ID: 199005
OMB.report
HHS/NIH
OMB 0925-0624
ICR 201108-0925-003
IC 199005
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0624 can be found here:
2016-05-03 - No material or nonsubstantive change to a currently approved collection
2016-01-27 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 5
Attach 1Di_CTSU Site Addition Form
Form and Instruction
5 Attach 1Di_Site Addition Form
Attach 1di_Add CTSU Site_Form_August2011.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Attach 1Di_CTSU Site Addition Form
Agency IC Tracking Number:
Is this a Common Form?
No
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
5
Attach 1Di_Site Addition Form
Attach 1di_Add CTSU Site_Form_August2011.pdf
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Clinical, Basic and Population-based Research Studies of hte National Institutes of Health (NIH), HHS/NIH/OD
FR Citation:
67 FR 60776
Number of Respondents:
25
Number of Respondents for Small Entity:
10
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
50 %
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
300
0
300
0
0
0
Annual IC Time Burden (Hours)
25
0
25
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.