Information Collection

Script to Explain Project and Obtain Consent

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Script to Explain Project and Obtain Consent	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	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 %

	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

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.