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Federal forms, ICRs, and supporting documents

Information Collection

Consent and Screener: Adults (Ages 26+)

IC 233738 under ICR 201810-0910-014 · OMB 0910-0873.

Documents and Forms
Document Name
Document Type
Other-Expressed Claims Screener
Other-Expressed Claims Informed Cons
Information Collection (IC) Details

View Information Collection (IC)

Consent and Screener: Adults (Ages 26+)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Expressed Claims Screener 4. Expressed Claims Screener.docx Yes Yes Fillable Fileable Signable
Other-Expressed Claims Informed Consent 5. Expressed Claims Informed Consent.docx Yes Yes Fillable Fileable Signable

Health Consumer Health and Safety

 

16,500 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 16,500 0 0 16,500 0 0
Annual IC Time Burden (Hours) 1,650 0 0 1,650 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.