Information Collection

Evaluation of Adolescent Pregnancy Prevention Approaches Household (Modified PPA) Survey

IC 199830 under ICR 201110-0990-004 · OMB 0990-0389.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-TPP Evaluation Attachment C_Baseline Instrument.docx	Other-survey
0990-TPP evaluation Attachment F_young adult consent.docx 0990-TPP evaluation Attachment F_young adult consent	IC Document
0990-TPP evaluation Attachment G_household notification.docx 0990-TPP evaluation Attachment G_household notification	IC Document
0990-TPP evaluation Attachment E_youth assent.docx 0990-TPP evaluation Attachment E_youth assent	IC Document
0990-TPP evaluation Attachment D_parental consent.docx 0990-TPP evaluation Attachment D_parental consent	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
Other-survey					Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,000

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	6,000	6,000
Annual IC Time Burden (Hours)	4,500	4,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-TPP evaluation Attachment F_young adult consent		10/21/2011
0990-TPP evaluation Attachment G_household notification		10/21/2011
0990-TPP evaluation Attachment E_youth assent		10/21/2011
0990-TPP evaluation Attachment D_parental consent		10/21/2011

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

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