Information Collection

Electronic Transmittal of Clinical Variables Archived in Clinic Databases--Data Manager/no form

IC 209255 under ICR 201311-0920-005 · OMB 0920-1002.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App 14 Informed consent forms.docx	Other-Records/Data extraction

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Records/Data extraction			App 14 Informed consent forms.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	576	576
Annual IC Cost Burden (Dollars)	11,667	11,667

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.