Information Collection

Informed Consent

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.