Information Collection

Adolescents

IC 7481 under ICR 200812-0925-001 · OMB 0925-0557.

Documents and Forms

Document Name Document Type
attach 5 (2).doc Instruction
1 survey 0557-surveys.pdf Form and Instruction
Attach 3.xls Attach 3 IC Document
attach 4 (2).doc attach 4 (2) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adolescents	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
Instruction			attach 5 (2).doc		Yes	Yes	Paper Only
Form and Instruction	1	survey	0557-surveys.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,672	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	14,672	-118	14,790
Annual IC Time Burden (Hours)	11,004	129	10,875
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attach 3	Attach 3.xls	11/10/2008
attach 4 (2)	attach 4 (2).doc	11/10/2008

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