Permission and Consent Form

Web-based Media Literacy Parent Training for Substance Use Prevention in Rural Locations

Documents and Forms

Document Name Document Type
Form 1 Permission and Consent Form Form and Instruction
1 Consent Form Attachment 14 Consent and permission forms.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Permission and Consent Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	1	Consent Form	Attachment 14 Consent and permission forms.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: SORN09-25-0200	FR Citation: 67 FR 60741

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
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.