Form 79 Protocol Specific DTL

Attachment_A19_ProtocolSpecific_DTL Template

OMB #xxxx-xxxx Expiration Date: xx/xx/xxxx

Public reporting burden for this collection of information is estimated to average 2 hours 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.

Figure 1 – Example CTSU LPO Form Creation Screen