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Attach 6 - Concept Clinical Trial Survey
Cancer Trials Support Unit (CTSU) Public Use Forms and Customer Satisfaction Surveys (NCI)
OMB: 0925-0624
IC ID: 209612
OMB.report
HHS/NIH
OMB 0925-0624
ICR 201604-0925-004
IC 209612
( )
Documents and Forms
Document Name
Document Type
Form 25
Attach 6 - Concept Clinical Trial Survey
Form and Instruction
25 Concept Clinical Trial Survey
attachment_6_conceptsurvey.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Attach 6 - Concept Clinical Trial Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
25
Concept Clinical Trial Survey
attachment_6_conceptsurvey.docx
Yes
Yes
Fillable Fileable
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:
500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
500
0
0
0
0
500
Annual IC Time Burden (Hours)
42
0
0
0
0
42
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.