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Record-keeping for Sterilization Consent Form

IC 191181 under ICR 201506-0937-001 · OMB 0937-0166.

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Record-keeping for Sterilization Consent Form
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 50.Sub Part B

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0937-0166 Sterilization Consent Form 0937-0166 Consent for Sterilization (English) - Expires 10_31_2015.docx No   Printable Only

Health Health Care Services

 

100,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100,000 0 0 0 0 100,000
Annual IC Time Burden (Hours) 25,000 0 0 0 0 25,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Transimital memo 0937-0166 transmital memo062515_145632.pdf 09/24/2015
60-day FRN 0937-0166 60-dayFederal Register, Volume 80 Issue 127 (Thursday, July 2, 2015).htm 09/24/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.