Objective 2 Risk Factor Informed Consent Adult HIV positive SCD patients

Characterization of risk of HIV and HIV outcomes in the Brazilian Sickle Cell Disease (SCD) population and comparison of SCD outcomes between HIV sero-positive and negative SCD patients

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Objective 2 Risk Factor Informed Consent Adult HIV positive SCD patients	Agency IC Tracking Number:

Is this a Common Form? No		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	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 %

	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

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.