Information Collection

Older Child Assent Form

IC 209543 under ICR 201609-2528-001 · OMB 2528-0259.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0259 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix D_36-Month Followup CHILD Survey.docx	Other-Child survey
Child Assent form Appendix A3_Child Assent Form_1_13.docx	Form

IC Title:

Older Child Assent Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Child survey			Appendix D_36-Month Followup CHILD Survey.docx		No		Paper Only
Form	N/A	Child Assent form	Appendix A3_Child Assent Form_1_13.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 883

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-883	883
Annual IC Time Burden (Hours)	-515	515
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.