Information Collection

Specific Consent Request Case Summary (Form L-2)

IC 245640 under ICR 202606-0970-003 · OMB 0970-0565.

Documents and Forms

Document Name Document Type
Form Form L-2 Specific Consent Request Case Summary Specific Consent Request Case Summary (Form L-2) Form and Instruction
Form L-2 Specific Consent Request Case Summary L-2 Specific Consent Request Case Summary_v3_Final (rev. 02.05.25).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Specific Consent Request Case Summary (Form L-2)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 45 CFR § 410.1209 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form L-2	Specific Consent Request Case Summary	L-2 Specific Consent Request Case Summary_v3_Final (rev. 02.05.25).pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: 09-80-0321 ORR Division of Children's Services Records	FR Citation: 81 FR 46682

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

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	10	10
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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