Information Collection

Consent

IC 192852 under ICR 201102-0920-004 · OMB 0920-0858.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Consent	Form
Consent for 16-17 year olds Attachment_8a_Consent Young Adults 16-17.doc	Form
Consent for parents Attachment_8b_Consent Parents.doc	Form
Consent for 18-19 year olds Attachment_9_Consent Young Adults 18-19 (3).doc	Form

IC Title:

Consent

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	none	Consent for parents	Attachment_8b_Consent Parents.doc	No	Paper Only
Form	none	Consent for 16-17 year olds	Attachment_8a_Consent Young Adults 16-17.doc	No	Paper Only
Form	none	Consent for 18-19 year olds	Attachment_9_Consent Young Adults 18-19 (3).doc	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 108

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.