Information Collection

Baseline survey -Adolescents 9-19Adolescent Family Life Pregnancy Prevention Core Evaluation

IC 10424 under ICR 200809-0990-003 · OMB 0990-0291.

Documents and Forms

Document Name Document Type
Form 0990-0291 Baseline survey -Adolescents 9-19Adolescent Family Life Pregnancy Prevention Core Evaluation Form
0990-0291 Baseline Survey 0990-0291Appendix B_Draft Prevention Baseline for grantees_OMB_09-02-08_MK.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Baseline survey -Adolescents 9-19Adolescent Family Life Pregnancy Prevention Core Evaluation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	0990-0291	Baseline Survey	0990-0291Appendix B_Draft Prevention Baseline for grantees_OMB_09-02-08_MK.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40,000	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	Previously Approved
Annual Number of Responses for this IC	40,000	-43,000	83,000
Annual IC Time Burden (Hours)	14,667	-26,833	41,500
Annual IC Cost Burden (Dollars)	0	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.