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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Youth Admin Guide Cohort N.docx Instruction
Youth Questionnair Youth Questionnaire Youth Questionnaire Cohort N.docx Form

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.