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Federal forms, ICRs, and supporting documents

Information Collection

SHIELD Model Consent (English)

IC 257892 under ICR 202503-0920-026 · OMB 0920-1402.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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SHIELD Model Consent (English) 0920-1402
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1402 Attachment 5A SHIELD Model and Actual Consent (English) Attachment 5A SHIELD Model and Actual Consent (English).docx Yes Yes Fillable Fileable

Health Health Care Services

 

2,000 0
   
Individuals or Households
 
   100 %

  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 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 167 0 0 0 0 167
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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