Information Collection

RSAF - Adolescent

IC 191556 under ICR 200912-0930-003 · OMB 0930-0311.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0311 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Adolescent Instrum RSAF - Adolescent	Form and Instruction
Adolescent Instrum Adolescent Instruments Adolescent Instruments.zip	Form and Instruction

IC Title:

RSAF - Adolescent

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 and Instruction	Adolescent Instruments	Adolescent Instruments	Adolescent Instruments.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	1,450	1,450
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.