Information Collection

Objective 1 Risk Factor Adult SCD cases and non-SCD controls Informed Consent

IC 218302 under ICR 201509-0925-003 · OMB 0925-0736.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Objective 1 Risk Factor Adult SCD cases and non-SCD controls Informed Consent	Form and Instruction
1 Attachment 2.1 Brazil SCD Obj. 1 Risk Factor Assessment Attachment_2.1_Brazil_SCD_Obj_1_Risk_Factor_Assessment_Consents_6_1_2015_V_9.0.docx	Form and Instruction
Attachment_6_Brazil_SCD_Obj_1_Risk_Factor_Assessment_Consents_Portuguese_7_21_2015_V_3.0.docx Attachment 6 Brazil SCD Obj. 1 Risk Factor Assessment Consents Portuguese	IC Document

IC Title:

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	1	Attachment 2.1 Brazil SCD Obj. 1 Risk Factor Assessment Consent	Attachment_2.1_Brazil_SCD_Obj_1_Risk_Factor_Assessment_Consents_6_1_2015_V_9.0.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 6 Brazil SCD Obj. 1 Risk Factor Assessment Consents Portuguese	Attachment_6_Brazil_SCD_Obj_1_Risk_Factor_Assessment_Consents_Portuguese_7_21_2015_V_3.0.docx	09/21/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.