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Prenatal Patient and Parent of Minor Consent
Evaluation of the Text4baby Program
OMB: 0915-0347
IC ID: 200144
OMB.report
HHS/HSA
OMB 0915-0347
ICR 201208-0915-006
IC 200144
( )
Documents and Forms
Document Name
Document Type
Consent.docx
Other-Explanation of burden associat
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Prenatal Patient and Parent of Minor Consent
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Other-Explanation of burden associated with consent
Consent.docx
No
No
Paper Only
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:
3,260
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
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
3,260
0
0
0
0
3,260
Annual IC Time Burden (Hours)
325
0
0
0
0
325
Annual IC Cost Burden (Dollars)
0
0
0
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.