Information Collection

Appx L_Consent Form Field Study (M)

IC 243407 under ICR 202008-0920-005 · OMB 0920-1331.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1331 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- Appx L_Consent Form Field Study (M)	Form and Instruction
0920- Health-related changes in cognitive performance - Field Appendix L Consent form field study.docx	Form and Instruction
0920- Health-related changes in cognitive performance - Field Appendix L Consent form field study.docx	Form and Instruction
Appendix K Recruitment Script - Field.docx Appx K_ Field Recruitment Script	IC Document
Appendix K Recruitment Script - Field.docx Appx K_ Field Recruitment Script	IC Document

IC Title:

Appx L_Consent Form Field Study (M)

Agency IC Tracking Number:

0920-20HO

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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 and Instruction	0920-	Health-related changes in cognitive performance - Field component	Appendix L Consent form field study.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appx K_ Field Recruitment Script	Appendix K Recruitment Script - Field.docx	08/31/2020

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