Information Collection

PHS Human Subjects and Clinical Trial Information (Part of Final RPPR, includes inclusion/enrollment)

IC 225115 under ICR 202003-0925-004 · OMB 0925-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0002 can be found here:

Documents and Forms

Document Name Document Type
Form 23 PHS Human Subjects and Clinical Trial Information (Part of Final RPPR, includes inclusion/enrollment) Form and Instruction
23 PHS Human Subjects and Clinical Trial Information- Inclu Attachment 5B PHS Human Subjects and Clinical Trial Information - Inclusion Enrollment Report_FORMS-F.pdf Form and Instruction
24 PHS Human Subjects and Clinical Trial Information Sectio Attachment 5B PHS Human Subjects and Clinical Trial Information - Sections 1-6_Includes Inclusion Enrollment Report_FORMS-F.pdf Form and Instruction
22 PHS Human Subjects and Clinical Trial Information Landin Attachment 5B PHS Human Subjects and Clinical Trial Information - Landing Page_FORMS-F.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PHS Human Subjects and Clinical Trial Information (Part of Final RPPR, includes inclusion/enrollment)	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	23	PHS Human Subjects and Clinical Trial Information- Inclusion Enrollment Report	Attachment 5B PHS Human Subjects and Clinical Trial Information - Inclusion Enrollment Report_FORMS-F.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	24	PHS Human Subjects and Clinical Trial Information Sections 1-6	Attachment 5B PHS Human Subjects and Clinical Trial Information - Sections 1-6_Includes Inclusion Enrollment Report_FORMS-F.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	22	PHS Human Subjects and Clinical Trial Information Landing Page	Attachment 5B PHS Human Subjects and Clinical Trial Information - Landing Page_FORMS-F.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	14,400	14,400
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.