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HRCT Scan informed consent
Understanding Long-term Respiratory Morbidity in Former Styrene-exposed Workers: Medical Survey
OMB: 0920-1332
IC ID: 249550
OMB.report
HHS/CDC
OMB 0920-1332
ICR 202109-0920-011
IC 249550
( )
Documents and Forms
Document Name
Document Type
Form 0920-21ID
HRCT Scan informed consent
Form
0920-21ID HRCT consent form
Attachment_4_StyreneCohort_HRCT consent form.docx
Form
0920-21ID HRCT consent form
Attachment_4_StyreneCohort_HRCT consent form.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HRCT Scan informed consent
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
0920-21ID
HRCT consent form
Attachment_4_StyreneCohort_HRCT consent form.docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
18
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
18
0
18
0
0
0
Annual IC Time Burden (Hours)
5
0
5
0
0
0
Annual IC Cost Burden (Dollars)
106
0
106
0
0
0
Documents for IC
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.