Inclusion Enrollment Form

The Inclusion Enrollment Report Form

Documents and Forms

Document Name Document Type
Form 1 Inclusion Enrollment Form Form
Attachment 2B_Inclusion Enrollment Report Instructions_Competing and noncompeting_FORMS-I.docx Instruction
1 Form Attachment 2A_PHSInclusionEnrollmentReport.pdf Form

Information Collection (IC) Details

IC Title:	Inclusion Enrollment Form	Agency IC Tracking Number:

Is this a Common Form? Yes		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	1	Form	Attachment 2A_PHSInclusionEnrollmentReport.pdf		Yes	Yes	Fillable Fileable
Instruction			Attachment 2B_Inclusion Enrollment Report Instructions_Competing and noncompeting_FORMS-I.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: NIH 09-25-0036, 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: 69,888	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	69,888	2,000	67,888
Annual IC Time Burden (Hours)	69,888	2,000	67,888
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.