Information Collection

Community Based Abstinence Education (Follow-up Test Survey)

IC 190225 under ICR 200908-0970-005 · OMB 0970-0272.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Community Based Abstinence Education (Follow-up Test Survey)	Form
1 Follow-up FR 0970-0272 Core measure survey follow-up (post-post) test 7-27-09.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Follow-up	FR 0970-0272 Core measure survey follow-up (post-post) test 7-27-09.doc		Yes	Yes	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 87 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500,000	500,000
Annual IC Time Burden (Hours)	125,000	125,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.