Information Collection

Informed Consent Form

IC 205863 under ICR 201511-0920-009 · OMB 0920-0964.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Informed Consent Form	Form
Informed Consent Attachment F Informed Consent.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	none	Informed Consent	Attachment F Informed Consent.docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: 09-20-0118 Study at Work Sites Where Agents Suspected of Being Occupational Hazards Exist

FR Citation: 51 FR 42469

Number of Respondents: 63

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	63	63
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.