Request and Consent Forms for Privacy Records

Documents and Forms

Document Name Document Type
Form AD 3123 Request and Consent Forms for Privacy Records Form
AD 3123 Privacy Act Consent Form AD-3123- Privacy Act Consent Form-AH 12 Jan 2023 FINAL.pdf Form
AD 3123 Privacy Act Consent Form AD-3123- Privacy Act Consent Form-AH 12 Jan 2023 FINAL.pdf Form
AD-3124 Privacy Act Request Form AD-3124 - Privacy Act Request Form-AH 12 Jan 2023 FINAL.pdf Form
AD-3124 Privacy Act Request Form AD-3124 - Privacy Act Request Form-AH 12 Jan 2023 FINAL.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request and Consent Forms for Privacy Records	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	AD 3123	Privacy Act Consent Form	AD-3123- Privacy Act Consent Form-AH 12 Jan 2023 FINAL.pdf		Yes	Yes	Fillable Fileable
Form	AD-3124	Privacy Act Request Form	AD-3124 - Privacy Act Request Form-AH 12 Jan 2023 FINAL.pdf		Yes	Yes	Fillable Fileable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title: USDA/OCIO-01 - Freedom of Information Act Express	FR Citation: 83 FR 14283

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	240	240
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.