Information Collection

Informed Consent - Pretest

IC 242548 under ICR 202010-0910-009 · OMB 0910-0890.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix D - Informed Consent- General Practitioners.docx	Other-Consent Form - GPs
Appendix D - Informed Consent - Specialist.docx	Other-Consent Form
Appendix D - Informed Consent- OB GYN Specialist.docx	Other-Consent Form

IC Title:

Agency IC Tracking Number:

CDER

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consent Form - GPs	Appendix D - Informed Consent- General Practitioners.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Appendix D - Informed Consent - Specialist.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Appendix D - Informed Consent- OB GYN Specialist.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.