Information Collection

Informed Consent

IC 256599 under ICR 202210-2127-005 · OMB 2127-0763.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1628 Informed Consent	Form and Instruction
1628 Informed Consent ADAS ICR Form 1628 Consent Form 111921-asg RAA.docx	Form and Instruction
1628 Informed Consent ADAS ICR Form 1628 Consent Form 111921-asg RAA.docx	Form and Instruction

IC Title:

Informed Consent

Agency IC Tracking Number:

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	1628	Informed Consent	ADAS ICR Form 1628 Consent Form 111921-asg RAA.docx		No		Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	4,338	4,338

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.