Information Collection

Mi Informed Consent for Repeat Appointments

IC 212541 under ICR 201407-0923-001 · OMB 0923-0044.

Documents and Forms

Document Name Document Type
Form 0923-0044 Mi Informed Consent for Repeat Appointments Form and Instruction
0923-0044 Att2_MI_Consent 20140724 Att2_MI_Consent 20140724.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Mi Informed Consent for Repeat Appointments	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	0923-0044	Att2_MI_Consent 20140724	Att2_MI_Consent 20140724.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	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	25	25
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.