Information Collection

Participant Consent/Assent

IC 279375 under ICR 202603-0930-001 · OMB 0930-0316.

Documents and Forms

Document Name Document Type
Form Participant Consen Participant Consent/Assent Participant Consent/Assent Form and Instruction
Participant Consen Participant Consent/Assent Participant Informed Consent and Assent__final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant Consent/Assent	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 and Instruction	Participant Consent/Assent	Participant Consent/Assent	Participant Informed Consent and Assent__final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Privacy Act 1974	FR Citation: 75 FR 28264

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	40	40
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.

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