Clinical Research Participants

Generic Clearance for Surveys of Customers and other Partners (CC)

Documents and Forms

Document Name Document Type
Form 1 Clinical Research Participants Form
1 Patient Survey 3rd Party Patient Survey.NIH Clinical Center.docx Form
3rd Party Study Mini-Supporting Statement - Clinical Center.docx 3rd Party Study Mini-Supporting Statement - Clinical Center IC Document
3rd Party Study Generic Clearance Form (2).docx 3rd Party Study Generic Clearance Form (2) IC Document
3rd Party Study Mini-Supporting Statement REVISED - Clinical Center (2).docx 3rd Party Study Mini-Supporting Statement REVISED - Clinical Center (2) IC Document

Information Collection (IC) Details

IC Title:	Clinical Research Participants	Agency IC Tracking Number:

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	1	Patient Survey	3rd Party Patient Survey.NIH Clinical Center.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 378	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	378	378
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
3rd Party Study Mini-Supporting Statement - Clinical Center	3rd Party Study Mini-Supporting Statement - Clinical Center.docx	04/13/2011
3rd Party Study Generic Clearance Form (2)	3rd Party Study Generic Clearance Form (2).docx	04/13/2011
3rd Party Study Mini-Supporting Statement REVISED - Clinical Center (2)	3rd Party Study Mini-Supporting Statement REVISED - Clinical Center (2).docx	04/21/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.