Information Collection

Community-Based Abstinence Education (Pre-test survey)

IC 43725 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 (Pre-test survey)	Form
1 Pre-test FR 0970-0272 Core measure survey pre-test 7-27-09.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 11 CFR Social Security Act (To search for a specific CFR, visit the Code of Federal Regulations.)

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	Pre-test	FR 0970-0272 Core measure survey pre-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: 1,000,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 87 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,000,000	999,500	500
Annual IC Time Burden (Hours)	250,000	245,500	4,500
Annual IC Cost Burden (Dollars)	0	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.