Information Collection

Teen Dating Violence Support Group Evaluation Survey (Baseline Survey)

IC 194255 under ICR 201104-0920-005 · OMB 0920-0861.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0861 can be found here:

Documents and Forms

Document Name Document Type
Teen Dating Violence Support Group Evaluation Survey (Baseline Survey) Form
Att D - Baseline Survey Attachment D - Baseline Survey Clean Version 3.2.11 kh.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Teen Dating Violence Support Group Evaluation Survey (Baseline Survey)	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Att D - Baseline Survey	Attachment D - Baseline Survey Clean Version 3.2.11 kh.doc		No	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: Records of Subjects in Health Promotion and Education Studies	FR Citation: 51 FR 42484

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	600	600
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.