Information Collection

Informed Consent Form

IC 205863 under ICR 201302-0920-015 · OMB 0920-0964.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0964 can be found here:

Documents and Forms

Document Name Document Type
Informed Consent Form Form
Informed Consent Attachment F Informed Consent Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Informed Consent Form	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	Informed Consent	Attachment F Informed Consent Form.docx		Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: 09-20-0118 Study at Work Sites Where Agents Suspected of Being Occupational Hazards Exist	FR Citation: 51 FR 42469

Number of Respondents: 125	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	10	10
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.