Private sector

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

Documents and Forms

Document Name Document Type
Form 1 Private sector Form
1 Application Attachment 1 - NIH Certificate of Confidentiality (CoC) Request Form Screenshots.docx Form
1 Form Assurance statement Feb 2025.docx Form

Information Collection (IC) Details

IC Title:	Private sector	Agency IC Tracking Number:

Is this a Common Form? No		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	Application	Attachment 1 - NIH Certificate of Confidentiality (CoC) Request Form Screenshots.docx		Yes	Yes	Fillable Fileable
Form	1	Form	Assurance statement Feb 2025.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0225, NIH Electronic Research Administration (eRA) Records, HHS/NIH/OD/OER	FR Citation: 67 FR 67042

Number of Respondents: 865	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
Annual Number of Responses for this IC	865	865
Annual IC Time Burden (Hours)	1,298	1,298
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.