CTSU LPO Form Creation (Attachment A19)

CTEP Branch Support Contracts Forms and Surveys (NCI)

Documents and Forms

Document Name Document Type
Form 79 CTSU LPO Form Creation (Attachment A19) Form
79 Protocol Specific DTL Attachment_A19_Prot_Spec_DTL.pdf Form

Information Collection (IC) Details

IC Title:	CTSU LPO Form Creation (Attachment A19)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	79	Protocol Specific DTL	Attachment_A19_Prot_Spec_DTL.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Clinical, Basic and Population -based Research Studies of the National Institutes of Health (NIH)	FR Citation: 67 FR 60742

Number of Respondents: 5	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	20	20
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.