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

ICR 202405-0925-003

OMB: 0925-0689

Federal Form Document

⚠️ Notice: This information collection may be outdated.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

2025-07-08 - Reinstatement without change of a previously approved collection
2024-11-13 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Form 1 Private sector Form and Instruction	Modified
Form 1 Private sector Form and Instruction	Modified
Attachment 1 Updated assurance statement May 2024.docx Supplementary Document	2024-05-27
Attachment 1 Updated assurance statement May 2024.docx Supplementary Document	2024-05-27
OMB change request May 2024.signed.pdf Justification for No Material/Nonsubstantive Change	2024-05-27
OMB change request May 2024.signed.pdf Justification for No Material/Nonsubstantive Change	2024-05-27
Revised assurance statement SEP2023.clean.docx Supplementary Document	2023-10-05
Revised assurance statement SEP2023.clean.docx Supplementary Document	2023-10-05
Markup assurance statement SEP2023.pdf Supplementary Document	2023-10-05
Markup assurance statement SEP2023.pdf Supplementary Document	2023-10-05
OMB change request SEP 2023.1signed.pdf Justification for No Material/Nonsubstantive Change	2023-10-04
OMB change request SEP 2023.1signed.pdf Justification for No Material/Nonsubstantive Change	2023-10-04
Updated assurance statement 06022023.pdf Supplementary Document	2023-06-15
Updated assurance statement 06022023.pdf Supplementary Document	2023-06-15
OMB change request JUN 2023.pk.pdf Justification for No Material/Nonsubstantive Change	2023-06-15
OMB change request JUN 2023.pk.pdf Justification for No Material/Nonsubstantive Change	2023-06-15
Change Request Memo.docx Justification for No Material/Nonsubstantive Change	2022-10-13
Change Request Memo.docx Justification for No Material/Nonsubstantive Change	2022-10-13
pub 30day FRN2022-05474.pdf Supplementary Document	2022-03-15
pub 30day FRN2022-05474.pdf Supplementary Document	2022-03-15
Attachment 2 - List of DHHS CoC Coordinators.docx Supplementary Document	2022-03-14
Attachment 2 - List of DHHS CoC Coordinators.docx Supplementary Document	2022-03-14
CoC Support_StatementA_FINAL_MAR2022.docx Supporting Statement A	2022-03-14
CoC Support_StatementA_FINAL_MAR2022.docx Supporting Statement A	2022-03-14
Attachment 3 - Privacy Impact Assessment (PIA) NOV 2021.pdf Supplementary Document	2022-03-14
Attachment 3 - Privacy Impact Assessment (PIA) NOV 2021.pdf Supplementary Document	2022-03-14
Attachment 4 - NIH Privacy Act Memo Applicability of the Privacy Act_CoC_FEB 2022.pdf Supplementary Document	2022-03-14
Attachment 4 - NIH Privacy Act Memo Applicability of the Privacy Act_CoC_FEB 2022.pdf Supplementary Document	2022-03-14

IC Document Collections

IC ID	Document Title	Status
252166	Private sector Form and Instruction	Modified
252166	Private sector Form and Instruction	Modified

ICR Details