Information Collection

Adolescents with Additional Assesments

IC 190912 under ICR 200910-0925-001 · OMB 0925-0610.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0610 can be found here:

Documents and Forms

Document Name Document Type
Form 9 Adolescents with Additional Assesments Form and Instruction
9 survey Attach 9 Form and Instruction
10 survey Attach 10 Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adolescents with Additional Assesments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	9	survey	Attach 9		Yes	Yes	Paper Only
Form and Instruction	10	survey	Attach 10		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750	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	750	750
Annual IC Time Burden (Hours)	1,875	1,875
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.