Head of household Consent

Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1356 can be found here:

Documents and Forms

Document Name Document Type
Head of household Consent Form and Instruction
Head of household consent AttachmentD_HeadOfHousehold_Consent_Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Head of household Consent	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	none	Head of household consent	AttachmentD_HeadOfHousehold_Consent_Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 702	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	702	702
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	667	667

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.