Human Animal interface patients Informed Consent Form

United States and Global Human Influenza Surveillance in at-Risk Settings (NIAID)

Documents and Forms

Document Name Document Type
Form 9 Human Animal interface patients Informed Consent Form Form and Instruction
9 Attachment 2 Representative Informed Consent Form ATTACHMENT 2 - Representative Informed Consent Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Human Animal interface patients Informed Consent Form	Agency IC Tracking Number:

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	9	Attachment 2 Representative Informed Consent Form	ATTACHMENT 2 - Representative Informed Consent Form.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	150	150
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.