Information Collection

Objectives 1 and 2 Consent Forms

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

Documents and Forms

Documents and forms in this information collection
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

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
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 %

table that charts list of burden
	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

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.