Information Collection

Consent to Participate and Information Release Form

IC 227014 under ICR 202101-2528-006 · OMB 2528-0259.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0259 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument B1- FOS_Consent to Participate_ Adult Respondent.docx	Other-Consent to Particpate
Instrument B2-FOS_Information Release Form.docx	Other-Information Release Form
Instrument B1- FOS_Consent to Participate_ Adult Respondent.docx Consent to Participate and Information Release Form	IC Document
Instrument B2-FOS_Information Release Form.docx Consent to Participate and Information Release Form	IC Document

IC Title:

Consent to Participate and Information Release Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

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
Other-Consent to Particpate			Instrument B1- FOS_Consent to Participate_ Adult Respondent.docx		No		Paper Only
Other-Information Release Form			Instrument B2-FOS_Information Release Form.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title: Homeless Families Impact Study Data Files

FR Citation: 79 FR 4202

Number of Respondents: 2,264

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-2,264	2,264
Annual IC Time Burden (Hours)	-385	385
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent to Participate and Information Release Form	Instrument B1- FOS_Consent to Participate_ Adult Respondent.docx	05/26/2017
Consent to Participate and Information Release Form	Instrument B2-FOS_Information Release Form.docx	05/26/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.