Information Collection

Script to Explain Project and Obtain Consent

IC 191059 under ICR 200910-0920-007 · OMB 0920-0838.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Script to Explain Project and Obtain Consent	Form
Script to Explain Project and Obtain Consent - Pregnant Attachment C2a 090309.doc	Form
Script to Explain Project and Obtain Consent - Breastfee Attachment C2b 090309.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Script to Explain Project and Obtain Consent - Pregnant Women	Attachment C2a 090309.doc		Yes	Yes	Fillable Fileable
Form	none	Script to Explain Project and Obtain Consent - Breastfeeding Women	Attachment C2b 090309.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.