Information Collection

Key Stakeholder Recruitment and Consent

IC 212623 under ICR 201605-0920-006 · OMB 0920-1038.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 4_Key Stakeholder Script.docx	Instruction
Key Stateholder Informed Consent Att 5_Key Stakeholder Informed Consent.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Instruction			Att 4_Key Stakeholder Script.docx		Yes	Yes	Fillable Fileable
Form	none	Key Stateholder Informed Consent	Att 5_Key Stakeholder Informed Consent.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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	Previously Approved
Annual Number of Responses for this IC	60	60
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.