Information Collection

Registration/Consent Process

IC 210861 under ICR 201403-0925-008 · OMB 0925-0696.

Documents and Forms

Document Name Document Type
Form 1 Registration/Consent Process Form and Instruction
1 Patient Registration Form Attachment 8 NIH Clinical Center Patient Registration Form.pdf Form and Instruction
Attachment 4 NHLBI Protocol 13-H-0183 Consent Document.pdf Attachment 4 NHLBI Protocol 13-H-0183 Consent Document IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Registration/Consent Process	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 and Instruction	1	Patient Registration Form	Attachment 8 NIH Clinical Center Patient Registration Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

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)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 4 NHLBI Protocol 13-H-0183 Consent Document	Attachment 4 NHLBI Protocol 13-H-0183 Consent Document.pdf	03/19/2014

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