Information Collection

Informed Consent

IC 215802 under ICR 201503-0925-008 · OMB 0925-0597.

Documents and Forms

Document Name Document Type
Form 1 Informed Consent Form and Instruction
Attach_6_Risk_Factor_Informed_Consent_Portuguese_2_2015_V_2.0.docx Other-Portuguese Inform Consent
1 Attachment 2 Risk Factor Informed Consent Attach_2_Risk_Factor_Informed Consent_2_2015_V_2.0.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Informed Consent	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	Attachment 2 Risk Factor Informed Consent	Attach_2_Risk_Factor_Informed Consent_2_2015_V_2.0.docx		Yes	Yes	Fillable Fileable
Other-Portuguese Inform Consent			Attach_6_Risk_Factor_Informed_Consent_Portuguese_2_2015_V_2.0.docx		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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
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.