Information Collection

Adults -Consent Process, In-Person Screening Xanax

IC 209127 under ICR 201310-0925-003 · OMB 0925-0692.

Documents and Forms

Document Name Document Type
Form 3 Adults -Consent Process, In-Person Screening Xanax Form
3 Adults - Consent Process,in-Person Screening Xanax Attachment 11(Informed Consent In-person Screening -Xanax) .pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adults -Consent Process, In-Person Screening Xanax	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	3	Adults - Consent Process,in-Person Screening Xanax	Attachment 11(Informed Consent In-person Screening -Xanax) .pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: SORN	FR Citation: 67 FR 60741

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	75	75
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.