Information Collection

Informed Consent

IC 261725 under ICR 202502-0920-009 · OMB 0920-1416.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-22DI Informed Consent	Form and Instruction
Form 0920-22DI Consent Informed Consent	Form and Instruction
0920-22DI Consent Attachment F_Consent form 04-2-23.docx	Form and Instruction
0920-22DI Consent Attachment F_Consent form 04-2-23.docx	Form and Instruction
Attachment F_Consent form 04-2-23.docx Attachment F_Consent form 04-2-23	IC Document
Attachment F_Consent form 04-2-23.docx Attachment F_Consent form 04-2-23	IC Document

IC Title:

Informed Consent

Agency IC Tracking Number:

0920-22DI

Is this a Common Form? No

IC Status: Unchanged

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	0920-22DI				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 167

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	167	167
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F_Consent form 04-2-23		08/23/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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