Parental Consent Form

Evaluation of Pregnancy Prevention Program Replications for High Risk and Hard to Reach Youth

Documents and Forms

Document Name Document Type
Form 1 Parental Consent Form Form and Instruction
1 Parental consent for youth participation in study Appendix B_Parents.Guardians of Youth Consent Forms.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Parental Consent Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form and Instruction	1	Parental consent for youth participation in study	Appendix B_Parents.Guardians of Youth Consent Forms.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,163	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,163	4,163
Annual IC Time Burden (Hours)	1,041	1,041
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.