Institutional Certification Template

Data and Specimen Hub (DASH) (NICHD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0744 can be found here:

Documents and Forms

Document Name Document Type
Form 3 Institutional Certification Template Form and Instruction
3 Institutional Certification Template 0925-0744_DASH_Attach-ment A.2-3_Institutional Certification Template (1).docx Form and Instruction
3 Institutional Certification Template 0925-0744_DASH_Attach-ment A.2-3_Institutional Certification Template (1).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Institutional Certification Template	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	3	Institutional Certification Template	0925-0744_DASH_Attach-ment A.2-3_Institutional Certification Template (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD	FR Citation: 67 FR 60742

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	3	3
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.