Information Collection

Informed Consent Form for Bhutanese and Burmese

IC 213774 under ICR 201411-0923-001 · OMB 0923-0052.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0052 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Informed Consent Form for Bhutanese and Burmese	Form and Instruction
Informed Consent Form for Bhutanese and Burmese Att8b_ConsentBhutan_Burm.docx	Form and Instruction

IC Title:

Informed Consent Form for Bhutanese and Burmese

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 and Instruction	None	Informed Consent Form for Bhutanese and Burmese	Att8b_ConsentBhutan_Burm.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	3	3
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.