Information Collection

POD Informed Consent Form

IC 227805 under ICR 201901-0960-002 · OMB 0960-0809.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0809 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form POD Informed Conse POD Informed Consent Form	Form
POD Advanced Letter - Revised.pdf	Other-Letter to Recruited Respondent
POD Trifold Brochure - Revised.pdf	Other-Informational Brochure
POD Informed Conse Promoting Opportunity Demonstration (POD) Voluntary Part POD Informed Consent Forms - Revised.pdf	Form

IC Title:

POD Informed Consent Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	Available Electronically?	Electronic Capability
Form	POD Informed Consent Form	Promoting Opportunity Demonstration (POD) Voluntary Participation Consent Form	POD Informed Consent Forms - Revised.pdf	No	Paper Only
Other-Letter to Recruited Respondents			POD Advanced Letter - Revised.pdf	No	Paper Only
Other-Informational Brochure			POD Trifold Brochure - Revised.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,500

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	Previously Approved
Annual Number of Responses for this IC	16,500	16,500
Annual IC Time Burden (Hours)	2,750	2,750
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.