Online Screening Instrument for Youth

Youth Advice and Feedback to Inform Choose Respect Implementation

OMB: 0920-0816

IC ID: 188375

Information Collection (IC) Details

View Information Collection (IC)

Online Screening Instrument for Youth
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Word Attach H Online Survey Screening Instrument for Youth REV 1-09 REV 4-28-10.doc Yes Yes Fillable Printable

Health Public Health Monitoring

 

400 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,600 0 0 0 0 1,600
Annual IC Time Burden (Hours) 80 0 0 0 0 80
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attach I Online Survey Youth Assent Form REV 1-9-09 Attach I Online Survey Youth Assent Form REV 1-9-09.doc 06/30/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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