OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Completes, Pretest 1

IC 236801 under ICR 202006-0910-002 · OMB 0910-0875.

Documents and Forms
Document Name
Document Type
Other-Survey Instrument
Other-Informed Consent
Information Collection (IC) Details

View Information Collection (IC)

Completes, Pretest 1 CDER
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey Instrument APPENDIX B questionnaire.docx Yes Yes Fillable Fileable
Other-Informed Consent APPENDIX D informed consent.docx Yes Yes Fillable Fileable

Health Health Care Services

 

158 0
   
Individuals or Households
 
   100 %

  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 158 0 0 0 0 158
Annual IC Time Burden (Hours) 53 0 0 0 0 53
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.