Information Collection

Request for Specific Consent to Junenile Court Jurisdiction

IC 195192 under ICR 201803-0970-001 · OMB 0970-0385.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Request for Specific Consent to Junenile Court Jurisdiction	Form and Instruction
1 Request for Specific Consent request_for_specific_consent_tjuvenile_court_jurisdiction_orr_c_1o_.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	1	Request for Specific Consent	request_for_specific_consent_tjuvenile_court_jurisdiction_orr_c_1o_.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 30

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	221	221

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.