Financial Disclosure Form (Attachments 5A or 5B)

Investigational Agent Accountability Record Forms in the Conduct of Investigational Trials in Cancer Treatment (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0613 can be found here:

Documents and Forms

Document Name Document Type
Form 5 Financial Disclosure Form (Attachments 5A or 5B) Form and Instruction
5 Attach 5 Financial Disclosure Form Attach_5A Financial_disclosure_form_final.pdf Form and Instruction
6 Attach 5B Financial Disclosure DCP Attach_5B-Financial Disclosure_DCP - Copy.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Financial Disclosure Form (Attachments 5A or 5B)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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	5	Attach 5 Financial Disclosure Form	Attach_5A Financial_disclosure_form_final.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	6	Attach 5B Financial Disclosure DCP	Attach_5B-Financial Disclosure_DCP - Copy.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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

Number of Respondents: 22,283	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-22,283	22,283
Annual IC Time Burden (Hours)	-1,857	1,857
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.