Request for 30-Day Access Form (Attach 2K)

NIH NCI Central Institutional Review Board (CIRB) Initiative (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0625 can be found here:

Documents and Forms

Document Name Document Type
Form 12 Request for 30-Day Access Form (Attach 2K) Form and Instruction
12 Request for 30-Day Access Form Attachment 2K - Request for 30-day Website Access Form_110110.pdf www.ncicirb.org/CIRB_Join.asp Form and Instruction

Information Collection (IC) Details

IC Title:	Request for 30-Day Access Form (Attach 2K)	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	12	Request for 30-Day Access Form	Attachment 2K - Request for 30-day Website Access Form_110110.pdf	http://www.ncicirb.org/CIRB_Join.asp	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0200 "Clinical, Basic and Population-based Research Studies of the Natonal Institutes of Health (NIH), HHS/NIH/OD"	FR Citation: 67 FR 60776

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	8	8
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.