Information Collection

Constituent Consent Form (Appendix C)

IC 262385 under ICR 202309-2528-002 · OMB 2528-0347.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Final - Appendix C_Constituent Consent Form.pdf	Other-Constituent Consent Form (Appe
Final - Appendix C_Constituent Consent Form.pdf	Other-Constituent Consent Form (Appe

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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-Constituent Consent Form (Appendix C)			Final - Appendix C_Constituent Consent Form.pdf		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: 96

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.