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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.