Consent Form 20110621 - LOI2-BIO-18

ATTACHMENT C.1.1
Exemplar Consent Form
OMB #: 0925-0593
Expiration Date: July 31, 2013

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may
not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:
NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed
form to this address.

ATTACHMENT C.1.1
Exemplar Consent Form
OMB #: 0925-0593
Expiration Date: July 31, 2013

ATTACHMENT C.1.1
Exemplar Consent Form
OMB #: 0925-0593
Expiration Date: July 31, 2013

ATTACHMENT C.1.1
Exemplar Consent Form
OMB #: 0925-0593
Expiration Date: July 31, 2013

You will be offered $25 to thank you for your participation.

ATTACHMENT C.1.1
Exemplar Consent Form
OMB #: 0925-0593
Expiration Date: July 31, 2013

ATTACHMENT C.1.1
Exemplar Consent Form
OMB #: 0925-0593
Expiration Date: July 31, 2013