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Informed Consent
HIV Outpatient Study (HOPS)
OMB: 0920-1080
IC ID: 216378
OMB.report
HHS/CDC
OMB 0920-1080
ICR 201808-0920-004
IC 216378
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1080 can be found here:
2023-05-26 - Extension without change of a currently approved collection
2021-01-07 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-1080
Informed Consent
Form
0920-1080 Consent to Participate in a Research Study
Att 4 Informed Consent Forms.docx
Form
Att 6 Screen Shots_Data Abstract Elements.pdf
Att 6_Screenshots _Data Abstraction Elements
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Informed Consent
Agency IC Tracking Number:
0920-1080
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
3 CFR 301.241(a)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
0920-1080
Consent to Participate in a Research Study
Att 4 Informed Consent Forms.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
450
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
450
0
0
0
0
450
Annual IC Time Burden (Hours)
113
0
0
0
0
113
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 6_Screenshots _Data Abstraction Elements
Att 6 Screen Shots_Data Abstract Elements.pdf
08/09/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.