Information Collection

Informed Consent

IC 216378 under ICR 201808-0920-004 · OMB 0920-1080.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1080 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1080 Informed Consent	Form
0920-1080 Consent to Participate in a Research Study Att 4 Informed Consent Forms.docx	Form
Att 6 Screen Shots_Data Abstract Elements.pdf Att 6_Screenshots _Data Abstraction Elements	IC Document

IC Title:

Informed Consent

Agency IC Tracking Number:

0920-1080

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 3 CFR 301.241(a)

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	0920-1080	Consent to Participate in a Research Study	Att 4 Informed Consent Forms.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 450

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	Previously Approved
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 6_Screenshots _Data Abstraction Elements	Att 6 Screen Shots_Data Abstract Elements.pdf	08/09/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.