Objective 1 Risk Factor Adult SCD cases and non-SCD controls Informed Consent

Characterization of risk of HIV and HIV outcomes in the Brazilian Sickle Cell Disease (SCD) population and comparison of SCD outcomes between HIV sero-positive and negative SCD patients

Documents and Forms

Document Name Document Type
Form 1 Objective 1 Risk Factor Adult SCD cases and non-SCD controls Informed Consent Form and Instruction
1 Attachment 2.1 Brazil SCD Obj. 1 Risk Factor Assessment Attachment_2.1_Brazil_SCD_Obj_1_Risk_Factor_Assessment_Consents_6_1_2015_V_9.0.docx Form and Instruction
Attachment_6_Brazil_SCD_Obj_1_Risk_Factor_Assessment_Consents_Portuguese_7_21_2015_V_3.0.docx Attachment 6 Brazil SCD Obj. 1 Risk Factor Assessment Consents Portuguese IC Document

Information Collection (IC) Details

IC Title:	Objective 1 Risk Factor Adult SCD cases and non-SCD controls 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 and Instruction	1	Attachment 2.1 Brazil SCD Obj. 1 Risk Factor Assessment Consent	Attachment_2.1_Brazil_SCD_Obj_1_Risk_Factor_Assessment_Consents_6_1_2015_V_9.0.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 6 Brazil SCD Obj. 1 Risk Factor Assessment Consents Portuguese	Attachment_6_Brazil_SCD_Obj_1_Risk_Factor_Assessment_Consents_Portuguese_7_21_2015_V_3.0.docx	09/21/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.