Consent to Participate- Adult Respondent (Appendix D)

Family Options 12-Year Study: Survey Data Collection – Phase II

Documents and Forms

Document Name Document Type
Final - Appendix D_Consent Form_Adult HoH.docx Other-Consent to Participate- Adult
Final 1-18-23-Appendix D_Consent Form_Adult HoH.docx Other-Consent to Participate- Adult

Information Collection (IC) Details

IC Title:	Consent to Participate- Adult Respondent (Appendix D)	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
Other-Consent to Participate- Adult Respondent (Appendix D)			Final 1-18-23-Appendix D_Consent Form_Adult HoH.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,241	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	2,241	2,241
Annual IC Time Burden (Hours)	381	381
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.