Information Collection

BEEA IA/NC Consent for RSG Home Visit or REG Home Visit or AMG Home Visit

IC 220895 under ICR 201604-0925-001 · OMB 0925-0406.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 8 BEEA IA/NC Consent for RSG Home Visit or REG Home Visit or AMG Home Visit	Form and Instruction
7 Attachment 18-1 and 18-2 BEEA IA/NC Informed Consent Ran Attachment 18-1 and 18-2_BEEA_IA_NC_Informed Consent_Random Select Group.pdf	Form and Instruction
8 Attachment 18-3 and 18-4 BEEA IA/NC Informed Consent Rec Attachment 18-3 and 18-4_BEEA_IA_NC_Informed Consent_Recent Exposure Group.pdf	Form and Instruction
9 Attachment 18-5 and 18-6 BEEA IA/NC Informed Consent Air Attachment 18-5 and 18-6_BEEA_IA_NC_Informed Consent_Air Monitoring Home Visit.pdf	Form and Instruction

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	Available Electronically?	Electronic Capability
Form and Instruction	8	Attachment 18-3 and 18-4 BEEA IA/NC Informed Consent Recent Exposure Group	Attachment 18-3 and 18-4_BEEA_IA_NC_Informed Consent_Recent Exposure Group.pdf	No	Paper Only
Form and Instruction	9	Attachment 18-5 and 18-6 BEEA IA/NC Informed Consent Air Monitoring Home Visit	Attachment 18-5 and 18-6_BEEA_IA_NC_Informed Consent_Air Monitoring Home Visit.pdf	No	Paper Only
Form and Instruction	7	Attachment 18-1 and 18-2 BEEA IA/NC Informed Consent Random Select Group	Attachment 18-1 and 18-2_BEEA_IA_NC_Informed Consent_Random Select Group.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0200 Clinical, Basic and Population-based Research Studies

FR Citation: 67 FR 60776

Number of Respondents: 196

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

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	196	196
Annual IC Time Burden (Hours)	16	16
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.