Informed Consent

[NIOSH] National Firefighter Registry for Cancer

Documents and Forms

Document Name Document Type
Informed Consent Form and Instruction
Informed Consent Attachment 3a. Informed Consent.docx Form and Instruction
Informed Consent Attachment 3a. Informed Consent.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Informed Consent	Agency IC Tracking Number:	0920-1348

Is this a Common Form? No		IC Status: Modified

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	n/a	Informed Consent	Attachment 3a. Informed Consent.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 66,666	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	66,666	0	66,666
Annual IC Time Burden (Hours)	5,555	-39,432	44,987
Annual IC Cost Burden (Dollars)	0	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.