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One-to-One Evaluation Study Parent Permission
Activities Associated with Developing a Web-based Resource for Youth about Clinical Research (NHLBI)
OMB: 0925-0729
IC ID: 217710
OMB.report
HHS/NIH
OMB 0925-0729
ICR 201511-0925-006
IC 217710
( )
Documents and Forms
Document Name
Document Type
Form 2
One-to-One Evaluation Study Parent Permission
Form and Instruction
2 Attachment I One-to-One Evaluation Study Parent Permissi
Attachment I_One-to-One Evaluation Study Parent Permission.doc
Form and Instruction
Attachment G_One-to-One Evaluation Study Flyer.pdf
Attachment G One-to-One Evaluation Study Flyer
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
One-to-One Evaluation Study Parent Permission
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
2
Attachment I One-to-One Evaluation Study Parent Permission
Attachment I_One-to-One Evaluation Study Parent Permission.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
5
0
5
0
0
0
Annual IC Time Burden (Hours)
0
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment G One-to-One Evaluation Study Flyer
Attachment G_One-to-One Evaluation Study Flyer.pdf
07/30/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.