HRCT Scan informed consent

Understanding Long-term Respiratory Morbidity in Former Styrene-exposed Workers: Medical Survey

Documents and Forms

Document Name Document Type
Form 0920-21ID HRCT Scan informed consent Form
0920-21ID HRCT consent form Attachment_4_StyreneCohort_HRCT consent form.docx Form
0920-21ID HRCT consent form Attachment_4_StyreneCohort_HRCT consent form.docx Form

Information Collection (IC) Details

IC Title:	HRCT Scan informed consent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-21ID	HRCT consent form	Attachment_4_StyreneCohort_HRCT consent form.docx		No		Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	106	106

Documents for IC

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.