Information Collection

Phase 2- Other Adult Household Member Informed Consent For Study Participation

IC 249837 under ICR 202310-2528-003 · OMB 2528-0337.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0337 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Revised - Attachment P Phase 2 Other Adult Household Member Informed Consent.docx	Other- Revised - Attachment P Phase
Revised - Attachment P Phase 2 Other Adult Household Member Informed Consent.docx	Other- Revised - Attachment P Phase

IC Title:

PHASE 2- OTHER ADULT HOUSEHOLD MEMBER INFORMED CONSENT FOR STUDY PARTICIPATION

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- Revised - Attachment P Phase 2 Other Adult Household Member Informed Consent			Revised - Attachment P Phase 2 Other Adult Household Member Informed Consent.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,050

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-5,050	5,050
Annual IC Time Burden (Hours)	-1,263	1,263
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.