OMB Number:
0925-0002
Study of
Cumulative
Inclusion Enrollment Report
This report format should NOT be used for collecting data from study participants.
Study
Title:
Comments:
Racial
Categories
Ethnic Categories
Not
Hispanic
or Latino
Female
Male
Unknown/Not
Reported
Hispanic
or
Latino
Female
Male
Unknown/Not
Reported
Unknown/Not
Reported Ethnicity
Female
Male
Unknown/Not
Reported
Total
American Indian/Alaska Native
Asian
Native Hawaiian or Other
Pacific
Islander
Black or African American
White
More than One Race
Unknown or Not Reported
Total