OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Informed Consent

IC 216378 under ICR 202011-0920-013 · OMB 0920-1080.

Documents and Forms
Document Name
Document Type
Other-Consent for HOPS Data Abstract
Other-Consent for HOPS Data Abstract
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Informed Consent 0920-1080
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Consent for HOPS Data Abstraction from Medical Chart Att 4_HOPS Informed Consent Forms.docx No   Paper Only

Health Illness Prevention

09-20-0160 Records of Subjects in Health Promotion and Education Studies  83 FR 6591

450 0
   
Individuals or Households
 
   0 %

  Approved 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 450 0 0 0 0 450
Annual IC Time Burden (Hours) 113 0 0 0 0 113
Annual IC Cost Burden (Dollars) 2,894 0 2,894 0 0 0

Title Document Date Uploaded
Data Items Abstracted from the Participant's Medical Chart by Study Personnel Att 6_Screen Shots_data abstraction_OpenClinica.pdf 12/21/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.