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Non-IND/NON-Treatment Registration Form (E05)
CTEP Branch Support Contracts Forms and Surveys (NCI)
OMB: 0925-0753
IC ID: 265725
OMB.report
HHS/NIH
OMB 0925-0753
ICR 202411-0925-001
IC 265725
( )
Documents and Forms
Document Name
Document Type
Form 1
Non-IND/NON-Treatment Registration Form (E05)
Form
1 Non-IND/Non-Treatment Registration Form
Attachment E05_NINT-Form_v1.10.0_blank_sansOMB.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Non-IND/NON-Treatment Registration Form (E05)
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
1
Non-IND/Non-Treatment Registration Form
Attachment E05_NINT-Form_v1.10.0_blank_sansOMB.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,000
0
0
0
0
1,000
Annual IC Time Burden (Hours)
1,000
0
0
0
0
1,000
Annual IC Cost Burden (Dollars)
0
0
0
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.