Consent Form

Study to Estimate Radiation Doses and Cancer Risk From Radioactive Fallout From The Trinity Nuclear Test (NCI)

Documents and Forms

Document Name Document Type
Form 2 Consent Form Form
2 Informed Consent ATTACHMENT 15A - Informed Consent_Edited_2_23_16-English.doc Form
3 Informed Consent SPANISH ATTACHMENT 15B - Informed Consent_Edited_2_23_16_SPANISH.doc Form

Information Collection (IC) Details

IC Title:	Consent Form	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	2	Informed Consent	ATTACHMENT 15A - Informed Consent_Edited_2_23_16-English.doc		No		Paper Only
Form	3	Informed Consent SPANISH	ATTACHMENT 15B - Informed Consent_Edited_2_23_16_SPANISH.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service	FR Citation: 67 FR 60743

Number of Respondents: 210	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	210	210
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.