Information Collection

Request for Specific Consent to Junenile Court Jurisdiction

IC 195192 under ICR 201403-0970-005 · OMB 0970-0385.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0385 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Request for Specific Consent to Junenile Court Jurisdiction Form and Instruction
1 Request for Specific Consent request_for_specific_consent_tjuvenile_court_jurisdiction_orr_c_1o_.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Specific Consent to Junenile Court Jurisdiction	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	Request for Specific Consent	request_for_specific_consent_tjuvenile_court_jurisdiction_orr_c_1o_.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 30

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	-42	72
Annual IC Time Burden (Hours)	10	-14	24
Annual IC Cost Burden (Dollars)	221	221	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.