Program Participants (girl and female adolescents)

Girls at Greater Risk for Juvenile Delinquency and HIV Prevention Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 6 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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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	No	No	Paper Only
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	No	No	Paper Only
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	No	No	Paper Only
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	No	No	Paper Only
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	No	No	Paper Only
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	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 %

	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

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.