Information Collection

Focus Group Screening Instrument for Parents and Youth

IC 188376 under ICR 201007-0920-006 · OMB 0920-0816.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0816 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attach M REV FG Screen Instrument for Youth - Script for Verbal Parental Consent REV 4-13-10.doc	Other-Word
Attach K FG Parental Permission-Consent Form 4-13-10.doc Attach K FG Parental Permission-Consent Form 4-13-10	IC Document
Attach L REV FG Youth Assent Form REV 4-13-10.doc Attach L REV FG Youth Assent Form REV 4-13-10	IC Document

IC Title:

Focus Group Screening Instrument for Parents and Youth

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Word			Attach M REV FG Screen Instrument for Youth - Script for Verbal Parental Consent REV 4-13-10.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 576

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,152	1,152
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach K FG Parental Permission-Consent Form 4-13-10	Attach K FG Parental Permission-Consent Form 4-13-10.doc	06/30/2010
Attach L REV FG Youth Assent Form REV 4-13-10	Attach L REV FG Youth Assent Form REV 4-13-10.doc	06/30/2010

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