Information Collection

Registration Questions for AI-Ethics Micro Lab Participation

IC 250498 under ICR 202010-0925-003 · OMB 0925-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 MicroLab Registration Registration Questions for AI-Ethics Micro Lab Participation	Form and Instruction
1 MicroLab Registration AI _ Ethics Microlab Registration_2021122.pdf	Form and Instruction
Mico Lab Registration Template.docx Micro Lab Registration Template	IC Document
Recruitment Materials AI Ethics Micro Lab Invitation Language-20211122.docx Recruitment Materials	IC Document

IC Title:

Registration Questions for AI-Ethics Micro Lab Participation

Agency IC Tracking Number:

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

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	1,000	1,000
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Micro Lab Registration Template		11/23/2021
Recruitment Materials		11/23/2021

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

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