Information Collection

Informed Consent

IC 247303 under ICR 202105-0920-002 · OMB 0920-1351.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1351 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-20PJ Informed Consent	Form and Instruction
0920-20PJ Informed Consent Attachment F_Informed Consent Form.docx	Form and Instruction
0920-20PJ Informed Consent Attachment F_Informed Consent Form.docx	Form and Instruction

IC Title:

Informed Consent

Agency IC Tracking Number:

0920-20PJ

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	0920-20PJ	Informed Consent	Attachment F_Informed Consent Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

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
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	50	50
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.