Information Collection

Youth Survey

IC 184508 under ICR 200804-0990-001 · OMB 0990-0325.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0325 can be found here:

Documents and Forms

Document Name Document Type
0990-PSUNCAPPENDIX B.doc Other-Survey
0990-PSUNCAPPENDIX C.doc Other-email reminder
0990-psuncConfidentiality Certificate.pdf Other-Confidential Certificate
0990-PSUNCAPPENDIX D.doc 0990-PSUNCAPPENDIX D IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Youth Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	0990-PSUNCAPPENDIX B.doc	No	No	Paper Only
Other-email reminder	0990-PSUNCAPPENDIX C.doc	No	No	Paper Only
Other-Confidential Certificate	0990-psuncConfidentiality Certificate.pdf	No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 760	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	760	760
Annual IC Time Burden (Hours)	253	253
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0990-PSUNCAPPENDIX D	0990-PSUNCAPPENDIX D.doc	03/10/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.