OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Phase 2 Consent

IC 218949 under ICR 202112-0920-002 · OMB 0920-1100.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Phase 2 Consent 0920-1100
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1100 Att 11a_Phase 2 Consent form (English) Att 11a_Phase 2 Consent form (English).docx Yes Yes Fillable Fileable
Form 0920-1100 Att 8b_Phase 2 Behavioral Survey (Spanish) Att 8b_Phase 2 Behavioral Survey (Spanish).docx Yes Yes Fillable Fileable

Health Health Care Services

 

50 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50 0 0 0 0 50
Annual IC Time Burden (Hours) 13 0 0 0 0 13
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.