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Study Staff Informed Consent Form
United States and Global Human Influenza Surveillance in at-Risk Settings (NIAID)
OMB: 0925-0737
IC ID: 218293
OMB.report
HHS/NIH
OMB 0925-0737
ICR 201509-0925-002
IC 218293
( )
Documents and Forms
Document Name
Document Type
Form 25
Study Staff Informed Consent Form
Form
25 Attachment 2 Representative Informed Consent Form
ATTACHMENT 2 - Representative Informed Consent Form.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Study Staff 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
25
Attachment 2 Representative Informed Consent Form
ATTACHMENT 2 - Representative Informed Consent Form.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
3,000
0
3,000
0
0
0
Annual IC Time Burden (Hours)
500
0
500
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
