Information Collection

Informed Consent

IC 239226 under ICR 202001-0910-003 · OMB 0910-0887.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0887 can be found here:

Documents and Forms

Document Name Document Type
Appendix C - Consent Form.docx Other-Informed Consent

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Informed Consent	Agency IC Tracking Number:	CTP

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
Other-Informed Consent			Appendix C - Consent Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 298	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	298	298
Annual IC Time Burden (Hours)	10	10
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.