Information Collection

Adolescent behavior and communication survey

IC 197270 under ICR 201104-0935-003 · OMB 0935-0184.

Documents and Forms

Document Name Document Type
Form Form #5 Adolescent behavior and communication survey Form and Instruction
Form #5 Adolescent Behavior and Communication Survey 6 Months Attachment G -- Adolescent Behavior and Communication Survey 6 Months.doc Form and Instruction
Form #4 Adolescent Behavior and Communication Survey Baseline Attachment F -- Adolescent Behavior and Communication Survey Baseline.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adolescent behavior and communication survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	Form #5	Adolescent Behavior and Communication Survey 6 Months	Attachment G -- Adolescent Behavior and Communication Survey 6 Months.doc		Yes	Yes	Fillable Printable
Form and Instruction	Form #4	Adolescent Behavior and Communication Survey Baseline	Attachment F -- Adolescent Behavior and Communication Survey Baseline.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 186	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	372	372
Annual IC Time Burden (Hours)	93	93
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.