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Federal forms, ICRs, and supporting documents

Information Collection

Information disclosure for sterilization consent forms

IC 7740 under ICR 202501-0937-001 · OMB 0937-0166.

Documents and Forms
Document Name
Document Type
Other-disclosure consent form
Other-disclosure consent form
Other-consent form in Spanish
Other-consent form in Spanish
Information Collection (IC) Details

View Information Collection (IC)

Information disclosure for sterilization consent forms
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 50.Sub Part B

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-disclosure consent form 0937-0166 Consent for Sterilization (English) FORM 687.docx No   Fillable Printable
Other-consent form in Spanish consent_for_sterilization_spanish_updated form.pdf No   Fillable Printable

Health Public Health Monitoring

 

100,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100,000 0 0 0 0 100,000
Annual IC Time Burden (Hours) 100,000 0 0 0 0 100,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.