Information Collection

Informed Consent form

IC 202909 under ICR 201206-0920-007 · OMB 0920-0947.

Documents and Forms

Document Name Document Type
Informed Consent form Form and Instruction
Informed Consent Attachment 4_Focus Group Informed Consent (rev08272012).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Informed Consent form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	none	Informed Consent	Attachment 4_Focus Group Informed Consent (rev08272012).docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 72	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	18	18
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.