Children's Wave Survey 2

Evaluation of the Parents Speak Up National Campaign: Youth Survey

Documents and Forms

Document Name Document Type
0990-psuncConfidentiality Certificate.pdf Other-Confidential Certificate
0990-0325Parents Speak Up National Campaign Children's Survey.doc Other-survey
0990-PSUNCParent E-mail Notification and Consent.doc Other-notification
0990-0325PSUNCTeen Assent Form.doc Other-consent form

Information Collection (IC) Details

IC Title:	Children's Wave Survey 2	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-Confidential Certificate	0990-psuncConfidentiality Certificate.pdf	No	No	Paper Only
Other-survey	0990-0325Parents Speak Up National Campaign Children's Survey.doc	No	No	Printable Only
Other-notification	0990-PSUNCParent E-mail Notification and Consent.doc	Yes	Yes	Paper Only
Other-consent form	0990-0325PSUNCTeen Assent Form.doc	Yes	Yes	Paper Only

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)	133	133
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.