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Adolescent behavior and communication survey consent-assent form

IC 197269 under ICR 201104-0935-003 · OMB 0935-0184.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

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Adolescent behavior and communication survey consent-assent form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #3 Adolescent behavior and communication survey consent-assent form Attachment E -- Adolescent Behavior and Communication Survey Consent-Assent.doc Yes Yes Paper Only

Health Immunization Management

 

776 0
   
Individuals or Households
 
   0 %

  Approved 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 776 0 776 0 0 0
Annual IC Time Burden (Hours) 194 0 194 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment D -- Adolescent Behavior and Communication Survey Information Letter Attachment D -- Adolescent Behavior and Communication Survey Information Letter.doc 03/30/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.