Form 94 Shipment Form (ASF)

Attachment E04 – NCI/DCTD/CTEP Agent Shipment Form (ASF)

OMB# 0925-0753
Expiration Date: 07/31/2021

Public reporting burden for this collection of information is estimated to be 10 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD
20892-7974, ATTN: PRA (OMB #0925-0753). Do not return the completed form to this address.

Screenshots

Figure 1: Electronic Capture of the Agent Shipment Summary

July 2018

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Breakdown of Elements

The Shipping Information Summary is a read-only display of the following shipping
information that is electronically captured:
1. Shipping Site: The following information can be selected or manually added for
the shipping site:
a. CTEP Site Code
b. Shipping Site: The name of the site.
c. Organization (Business) Address
2. Shipping Address: The shipping address can be selected or manually added for
the shipping site.
3. Shipping Designee (SD): The following information can be selected or manually
added for the SD:
a. CTEP Person ID
b. Name
c. Registration Status: If manually adding, the investigator can select the
SD’s registration status from a drop-down list of values.
d. CTEP Site Code
e. Primary Organization
4. Shipping Contact Information: The following information can be edited:
a. Telephone
b. Email
5. Ordering Designee (OD): The following information can be selected or manually
added after clicking the ‘Add new OD’ button:
a. CTEP Person ID
b. Name
c. Registration Status
d. CTEP Site Code
e. Primary Organization
f. Primary Contact Information

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