Information Collection

Data Collection Checklist (2009 & 2011 YRBS)

IC 184922 under ICR 200805-0920-010 · OMB 0920-0493.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0493 can be found here:

Documents and Forms

Document Name Document Type
Appendix I - Data Collection Checklist YRBS.doc Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Data Collection Checklist (2009 & 2011 YRBS)	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
Other-WORD			Appendix I - Data Collection Checklist YRBS.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	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	400	400
Annual IC Time Burden (Hours)	100	100
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.