Information Collection

Adults - Dosing/Driving/Waiting/ - (Intervention)

IC 209131 under ICR 201310-0925-003 · OMB 0925-0692.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 11 Informed Consent- Adderall Adults - Dosing/Driving/Waiting/ - (Intervention)	Form and Instruction
Form 12 Informed Consent - Xanax Adults - Dosing/Driving/Waiting/ - (Intervention)	Form and Instruction
Form 13 Informed Consent - Cannabis Adults - Dosing/Driving/Waiting/ - (Intervention)	Form and Instruction
11 Informed Consent- Adderall Attachment 10(Informed Consent In-person Screening- Adderall).pdf	Form and Instruction
12 Informed Consent - Xanax Attachment 11(Informed Consent In-person Screening -Xanax) .pdf	Form and Instruction
13 Informed Consent - Cannabis Attachment 12(Informed Consent In-person Screening -Cannabis).pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	11	Yes	Yes	Fillable Fileable
Form and Instruction	12	Yes	Yes	Fillable Fileable
Form and Instruction	13	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: SORN

FR Citation: 7 FR 60741

Number of Respondents: 72

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 Agency Discretion
Annual Number of Responses for this IC	144	144
Annual IC Time Burden (Hours)	576	576
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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