Information Collection

Community Member - Youth

IC 193428 under ICR 201006-0930-003 · OMB 0930-0315.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Community_Youth_In Community Member - Youth	Form and Instruction
Community_Youth_In Community_Youth_Instruments Attachment 11-Community_Youth_Instruments.pdf	Form and Instruction
Community_Youth_In Attachment 11-Youth Instrument Revised 9-30-10 Attachment 11-Youth_Instrument-Revised 09-30-10.pdf	Form and Instruction
Attachment 12-Community_Youth_Supporting.pdf Community_Youth_Supporting	IC Document

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 and Instruction	Community_Youth_Instruments	Community_Youth_Instruments	Attachment 11-Community_Youth_Instruments.pdf		Yes	Yes	Paper Only
Form and Instruction	Community_Youth_Instruments	Attachment 11-Youth Instrument Revised 9-30-10	Attachment 11-Youth_Instrument-Revised 09-30-10.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,234

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,234	2,234
Annual IC Time Burden (Hours)	1,676	1,676
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Community_Youth_Supporting	Attachment 12-Community_Youth_Supporting.pdf	06/10/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.