CoC Applicants - Small Business

Electronic Application for NIH Certificates of Confidentialty (CoC E-application System)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0689 can be found here:

Documents and Forms

Document Name Document Type
Form 1 CoC Applicants - Small Business Form and Instruction
1 NIH Certificate of Confidentiality Request Form Screensh CoC v2_with burden disclosure.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	CoC Applicants - Small Business	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	1	NIH Certificate of Confidentiality Request Form Screenshot	CoC v2_with burden disclosure.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: NIH Privacy Act Systems of Record 09-25-0156, “Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD	FR Citation: 67 FR 60742

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53	53
Annual IC Time Burden (Hours)	80	80
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.