Information Collection

Teen Assent or Teen 18+ Consent

IC 264294 under ICR 202501-0925-002 · OMB 0925-0781.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Teen Assent or Teen 18+ Consent	Form
Form 1 Assent Teen Assent or Teen 18+ Consent	Form
Form 2 Consent Teen Assent or Teen 18+ Consent	Form
1 Assent Att E - Teen Assent dated 03-20-24 Stamped.pdf	Form
1 Assent Att E - Teen Assent dated 03-20-24 Stamped.pdf	Form
2 Consent Att F - Teen 18+ Consent dated 03-20-24 Stamped.pdf	Form
2 Consent Att F - Teen 18+ Consent dated 03-20-24 Stamped.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Form	1				Yes	Yes	Fillable Fileable
Form	2				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	6	6
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.

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