Information Collection

eConsent surveys

IC 200902 under ICR 201208-0955-005 · OMB 0955-0005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0005 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0376_20111215_eConsent_Survey_v1.docx	Other-survey
0990-0376_eConsent surveyMini Supporting Statement Approved Generic.docx 0990-0376_eConsent surveyMini Supporting Statement Approved Generic	IC Document
0990-0376_20111215_eConsent_cover_letter_v1.docx 0990-0376_20111215_eConsent_cover_letter_v1	IC Document

IC Title:

eConsent surveys

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
Other-survey			0990-0376_20111215_eConsent_Survey_v1.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	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	2,800	0	0	0	0	0
Annual IC Time Burden (Hours)	233	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
0990-0376_eConsent surveyMini Supporting Statement Approved Generic	0990-0376_eConsent surveyMini Supporting Statement Approved Generic.docx	12/21/2011
0990-0376_20111215_eConsent_cover_letter_v1	0990-0376_20111215_eConsent_cover_letter_v1.docx	12/21/2011

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