Refusal to Consent

Human Reliability Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-5122 can be found here:

Documents and Forms

Document Name Document Type
Form DOE F 470.6 Refusal to Consent Form
DOE F 470.6 Refusal of Consent 470-6[1].pdf Form

Information Collection (IC) Details

IC Title:	Refusal to Consent	Agency IC Tracking Number:	Felecia Briggs

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 712.15(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DOE F 470.6	Refusal of Consent	470-6[1].pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,340	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-10,340	10,340
Annual IC Time Burden (Hours)	-6,204	6,204
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.