Information Collection

Objective 2 Risk Factor Informed Consent Adult HIV positive SCD patients

IC 218303 under ICR 201509-0925-003 · OMB 0925-0736.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Objective 2 Risk Factor Informed Consent Adult HIV positive SCD patients	Form and Instruction
2 Attachment 2.2 Brazil SCD Obj. 2 Risk Factor Assessemtn Attachment_2.2_Brazil_SCD_Obj_2_Risk_Factor_Assessment_Consent_9231_2015_V_9.0.docx	Form and Instruction
Attachment_7_Brazil_SCD_Obj_2_Risk_Factor_Assessment_Consent_Portuguese_9_23_2015_V_3.0.docx Attachment 7 Brazil SCD Obj. 2 Risk Factor Assessment Consent 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	2	Attachment 2.2 Brazil SCD Obj. 2 Risk Factor Assessemtn Consent	Attachment_2.2_Brazil_SCD_Obj_2_Risk_Factor_Assessment_Consent_9231_2015_V_9.0.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

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	25	25
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 7 Brazil SCD Obj. 2 Risk Factor Assessment Consent Portuguese	Attachment_7_Brazil_SCD_Obj_2_Risk_Factor_Assessment_Consent_Portuguese_9_23_2015_V_3.0.docx	09/29/2015

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