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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.