Information Collection

Interview with Middle Schoolers

IC 198630 under ICR 201107-0920-005 · OMB 0920-0897.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Interview with Middle Schoolers	Form
Discussion Guide for Middle Schoolers I-1 Middle Schoolers Youth Book Guide.doc	Form
I-2 Middle Schoolers Parent Information Sheet.doc Att I2 - Info Sheet for Parents	IC Document
I-3 Middle Schooler Parental Consent.doc Att I3 - Parental Consent	IC Document
I-4 Middle Schooler Youth Assent Form.doc Att I4 - Youth Assent	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Discussion Guide for Middle Schoolers	I-1 Middle Schoolers Youth Book Guide.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8

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	8	8
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att I2 - Info Sheet for Parents	I-2 Middle Schoolers Parent Information Sheet.doc	07/20/2011
Att I3 - Parental Consent	I-3 Middle Schooler Parental Consent.doc	07/20/2011
Att I4 - Youth Assent	I-4 Middle Schooler Youth Assent Form.doc	07/20/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.