Information Collection

Informed Consent

IC 257458 under ICR 202212-2127-005 · OMB 2127-0764.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1689 Informed Consent	Form and Instruction
1689 Focus Group Consent Form - Drivers PRA_InformedConsentDriver_CPSRideshare_2127-New_12.9.22.docx	Form and Instruction
1689 Focus Group Consent Form - Drivers PRA_InformedConsentDriver_CPSRideshare_2127-New_12.9.22.docx	Form and Instruction
1688 Focus Group Consent Form - Caregivers PRA_InformedConsentCaregiver_CPSRideshare_2127-New_092022 ncc 12.9.22.docx	Form and Instruction
1688 Focus Group Consent Form - Caregivers PRA_InformedConsentCaregiver_CPSRideshare_2127-New_092022 ncc 12.9.22.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	1689	Focus Group Consent Form - Drivers	PRA_InformedConsentDriver_CPSRideshare_2127-New_12.9.22.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1688	Focus Group Consent Form - Caregivers	PRA_InformedConsentCaregiver_CPSRideshare_2127-New_092022 ncc 12.9.22.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	96	96

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.