Information Collection

Objectives 1 and 2 Consent Forms

IC 210550 under ICR 201402-0925-003 · OMB 0925-0699.

Documents and Forms

Document Name Document Type
Form 1 Objectives 1 and 2 Consent Forms Form
1 Consent Form Attachment 1A HIV_HBV_Objectives_1_2_Consent_Form_1_2014_V_2 0.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Objectives 1 and 2 Consent Forms	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	1	Consent Form	Attachment 1A HIV_HBV_Objectives_1_2_Consent_Form_1_2014_V_2 0.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 483	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	483	483
Annual IC Time Burden (Hours)	121	121
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.