Information Collection

MOSAIC Study Sign Up and Informed Consent

IC 269979 under ICR 202408-0703-001 · OMB 0703-0099.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0703-0099 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MOSAIC Study Sign-up Form.docx	Other-Web Form
MOSAIC Study Sign-up Form_10SEP24.docx	Other-Web Form
MOSAIC Informed Consent 15JUN24_updated.rtf	Other-Informed Consent
MOSAIC Informed Consent 15JUN24_updated.rtf	Other-Informed Consent

IC Title:

MOSAIC Study Sign Up and 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
Other-Web Form					Yes	Yes	Fillable Fileable
Other-Informed Consent					Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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	60	60
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	152	152

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.

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