Information Collection

Informed Consent

IC 196081 under ICR 202101-0920-010 · OMB 0920-0888.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 4 - Informed Consent_2021-2-16.docx	Other-Informed Consent
Attachment 4 - Informed Consent_2021-2-16.docx	Other-Informed Consent

IC Title:

Informed Consent

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Informed Consent			Attachment 4 - Informed Consent_2021-2-16.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Occupational Health Epidemiolgical Studies and EEOICPA Program Records

FR Citation: 76 FR 34706

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	90	0	90
Annual IC Time Burden (Hours)	23	0	23
Annual IC Cost Burden (Dollars)	327	327	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.