Information Collection

Youth Questionnaire

IC 199787 under ICR 201110-0930-002 · OMB 0930-0298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0298 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Youth Admin Guide Cohort N.docx	Instruction
Youth Questionnair Youth Questionnaire Youth Questionnaire Cohort N.docx	Form

IC Title:

Youth Questionnaire

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
Instruction			Youth Admin Guide Cohort N.docx		Yes	No	Paper Only
Form	Youth Questionnaire	Youth Questionnaire	Youth Questionnaire Cohort N.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,128

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,612	3,612
Annual IC Time Burden (Hours)	2,610	2,610
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.