Information disclosure for sterilization consent forms

42 C.F.R. Subpart B: Sterilization of Persons in Federally Assisted Family Planning Projects

Documents and Forms

Document Name Document Type
0937-0166 Consent for Sterilization (English) FORM 687.docx Other-disclosure consent form
0937-0166 Consent for Sterilization (English) FORM 687.docx Other-disclosure consent form
consent-for-sterilization-spanish-updated form.pdf Other-consent form in Spanish
consent-for-sterilization-spanish-updated form.pdf Other-consent form in Spanish

Information Collection (IC) Details

IC Title:	Information disclosure for sterilization consent forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 50.Sub Part B

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-disclosure consent form			0937-0166 Consent for Sterilization (English) FORM 687.docx		No		Fillable Printable
Other-consent form in Spanish			consent-for-sterilization-spanish-updated form.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	100,000	100,000
Annual IC Cost Burden (Dollars)	0	0

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.