NeuroBioBank Tissue Access Request Form

Neurobiobank Tissue Access Request (NBB) NIMH

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0723 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NeuroBioBank Tissue Access Request Form Form and Instruction
1 NBB Tissue Access Request Form Att 1 - Updated NBB Tissue Access Request Form_09.07.21.pdf Form and Instruction
1 NBB Tissue Access Request Form Att 1 - Updated NBB Tissue Access Request Form_09.07.21.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	NeuroBioBank Tissue Access Request Form	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	1	NBB Tissue Access Request Form	Att 1 - Updated NBB Tissue Access Request Form_09.07.21.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Extramural Awards and Chartered Advisory Committees (IMPAC 2), Contract Information (DCIS), and Cooperative Agreement Information, HHS/NIH	FR Citation: 67 FR 60742

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	175	225
Annual IC Time Burden (Hours)	100	44	56
Annual IC Cost Burden (Dollars)	0	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.