Board Members

Web-Based Assessment of the Clinical Studies Support Center (CSSC)

Documents and Forms

Document Name Document Type
Form 4 Board Members Form and Instruction
4 Member Questionaire Attachment #4 CSSC Member Questionnaire.docx Form and Instruction
5b Assessment Screens Members Attachment #5b- Draft CSSC Assessment Screens-Members.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Board Members	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	4	Member Questionaire	Attachment #4 CSSC Member Questionnaire.docx		Yes	Yes	Paper Only
Form and Instruction	5b	Assessment Screens Members	Attachment #5b- Draft CSSC Assessment Screens-Members.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 79	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	79	79
Annual IC Time Burden (Hours)	26	26
Annual IC Cost Burden (Dollars)	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.