Information Collection

Sub-Study #2_Informed Consent and Incidental Emotion

IC 204704 under ICR 201111-0925-003 · OMB 0925-0645.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0645 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Screener Sub-Study #2_Informed Consent and Incidental Emotion	Form and Instruction
Form 2 Questionnaire (Screenshots) Sub-Study #2_Informed Consent and Incidental Emotion	Form and Instruction
1 Screener #2F_Attach_IC_Screener.doc	Form and Instruction
2 Questionnaire (Screenshots) #2Cii_Attach_IC_Questionnaire-ScreenShots.docx	Form and Instruction
#2B_Attach_IC_Consent to Read Only.doc #2B_Attach_IC_Consent to Read Only	IC Document
#2A_Attach_IC_Film Clips.doc #2A_Attach_IC_Film Clips	IC Document
#2Ci_Attach_IC_Questionnaire-Word.doc #2Ci_Attach_IC_Questionnaire-Word	IC Document
#2D_Attach_IC_Readings.doc #2D_Attach_IC_Readings	IC Document
#2E_Attach_IC_Advertisement.doc #2E_Attach_IC_Advertisement	IC Document
#2G_Attach_IC_Reminder Letter.docx #2G_Attach_IC_Reminder Letter	IC Document
#2H_IRB Approval.pdf #2H_IRB Approval	IC Document
#2_Justif Memo_IC_InformedConsent.doc #2_Justif Memo_IC_InformedConsent	IC Document

IC Title:

Sub-Study #2_Informed Consent and Incidental Emotion

Agency IC Tracking Number:

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 and Instruction	1	Screener	#2F_Attach_IC_Screener.doc		No	No	Printable Only
Form and Instruction	2	Questionnaire (Screenshots)	#2Cii_Attach_IC_Questionnaire-ScreenShots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: SORN #09-25-0200, "Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD"

FR Citation: 67 FR 60776

Number of Respondents: 520

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	520	0	0	0	0	0
Annual IC Time Burden (Hours)	287	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
#2B_Attach_IC_Consent to Read Only	#2B_Attach_IC_Consent to Read Only.doc	10/23/2012
#2A_Attach_IC_Film Clips	#2A_Attach_IC_Film Clips.doc	10/23/2012
#2Ci_Attach_IC_Questionnaire-Word	#2Ci_Attach_IC_Questionnaire-Word.doc	10/23/2012
#2D_Attach_IC_Readings	#2D_Attach_IC_Readings.doc	10/23/2012
#2E_Attach_IC_Advertisement	#2E_Attach_IC_Advertisement.doc	10/23/2012
#2G_Attach_IC_Reminder Letter	#2G_Attach_IC_Reminder Letter.docx	10/23/2012
#2H_IRB Approval	#2H_IRB Approval.pdf	10/23/2012
#2_Justif Memo_IC_InformedConsent	#2_Justif Memo_IC_InformedConsent.doc	10/23/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.