Information Collection

Informed Consent

IC 244765 under ICR 202606-0920-001 · OMB 0920-1348.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-26-0116 Informed Consent Informed Consent	Form and Instruction
0920-26-0116 Informed Consent Attachment 3a. Informed Consent.docx	Form and Instruction

IC Title:

Informed Consent

Agency IC Tracking Number:

0920-1348

Is this a Common Form? No

IC Status: Modified

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	0920-26-0116				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 33,333

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	33,333	33,333
Annual IC Time Burden (Hours)	2,783	2,783
Annual IC Cost Burden (Dollars)	0	0

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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