Record-keeping for Sterilization Consent Form

42 C.F.R. Subpart B: Sterilization of Persons in Federally Assisted Family Planning Projects

OMB: 0937-0166

IC ID: 191181

Information Collection (IC) Details

View Information Collection (IC)

Record-keeping for Sterilization Consent Form
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 50.Sub Part B

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0937-0166 Sterilization Consent Form 0937-0166 Consent for Sterilization (English) FORM 687 (002).docx No   Printable Only
Other-Form consent-for-sterilization-spanish-updated form.pdf No   Printable Only

Health Health Care Services

 

100,000 0
   
Individuals or Households
 
   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 100,000 0 0 0 100,000 0
Annual IC Time Burden (Hours) 25,000 0 0 0 25,000 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
60-day FRN 2022-03130 60D FRN.pdf 04/28/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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