MOSAIC Study Sign Up and Informed Consent

Male Survivors of Sexual Assault – Investigating Challenges around seeking help (MOSAIC)

Documents and Forms

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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Form			MOSAIC Study Sign-up Form_10SEP24.docx		Yes	Yes	Fillable Fileable
Other-Informed Consent			MOSAIC Informed Consent 15JUN24_updated.rtf		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 %

	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

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.