Information Collection

Supplemental Consent Forms

IC 227870 under ICR 201708-0920-011 · OMB 0920-1219.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 7. Cover Sheet for Supplemental Consent Forms.doc	Instruction
Teen consent for future contact Attachment 7.a - SEED Teen Consent Form for Future Contact_ver Feb 2018.docx	Form and Instruction
Teen consent for genetic sharing - mother Attachment 7.b.1 - SEED Teen Consent for Genetic Data Sharing_v1 Mother_ver Feb 2018.docx	Form and Instruction
Teen consent for generic data sharing - legal guardian Attachment 7.b.2 - SEED Teen Consent for Genetic Data Sharing_v2 Legal Guardian_ver Feb 2018.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Instruction			Attachment 7. Cover Sheet for Supplemental Consent Forms.doc	No	Paper Only
Form and Instruction	none	Teen consent for future contact	Attachment 7.a - SEED Teen Consent Form for Future Contact_ver Feb 2018.docx	No	Paper Only
Form and Instruction	none	Teen consent for genetic sharing - mother	Attachment 7.b.1 - SEED Teen Consent for Genetic Data Sharing_v1 Mother_ver Feb 2018.docx	No	Paper Only
Form and Instruction	none	Teen consent for generic data sharing - legal guardian	Attachment 7.b.2 - SEED Teen Consent for Genetic Data Sharing_v2 Legal Guardian_ver Feb 2018.docx	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveilance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 142

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	142	142
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	206	206

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.