Information Collection

Program Participants (girl and female adolescents)

IC 194091 under ICR 201009-0990-004 · OMB 0990-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0360 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6 Follow-Up Form for Participants aged 12-17 Program Participants (girl and female adolescents)	Form
Form 1 Pre-Test Form for Participants aged 9-11 Program Participants (girl and female adolescents)	Form
Form 2 Post-Test Form for Participants aged 9-11 Program Participants (girl and female adolescents)	Form
Form 3 Follow-up Form for Participants aged 9-11 Program Participants (girl and female adolescents)	Form
Form 4 Pre-Test Form for Participants aged 12-17 Program Participants (girl and female adolescents)	Form
Form 5 Post-Test Form for Participants aged 12-17 Program Participants (girl and female adolescents)	Form
1 Pre-Test Form for Participants aged 9-11 Respondent-Program Participants aged 9-11 years pre-test instrument 9_16_10[1].doc	Form
2 Post-Test Form for Participants aged 9-11 Respondent-Program Participants aged 9-11 years post-test instrument 9_14_10[1].doc	Form
3 Follow-up Form for Participants aged 9-11 Respondent-Program Participants aged 9-11 years follow-up instrument 9_14_10[1].doc	Form
4 Pre-Test Form for Participants aged 12-17 Respondent-Program Participants aged 12-17 years pre-test instrument 9_16_10[1].doc	Form
5 Post-Test Form for Participants aged 12-17 Respondent-Program Participants aged 12-17 years post-test instrument 9_14_10[1].doc	Form
6 Follow-Up Form for Participants aged 12-17 Respondent-Program Participants aged 12-17 years follow-up instrument 9_14_10[1].doc	Form

IC Title:

Program Participants (girl and female adolescents)

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	No	No	Paper Only
Form	2	No	No	Paper Only
Form	3	No	No	Paper Only
Form	4	No	No	Paper Only
Form	5	No	No	Paper Only
Form	6	No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	3,000	3,000
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.

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