Non Sexually active youth Part B2 of the baseline survey to be used with youth who have

Teen Pregnancy Prevention Replication Evaluation: Baseline Data

Documents and Forms

Document Name Document Type
TPP Replication Study Baseline-Attachment G Survey Part B2 non-sexually active 5.17.12.doc Other-Survey

Information Collection (IC) Details

IC Title:	Non Sexually active youth Part B2 of the baseline survey to be used with youth who have	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
Other-Survey			TPP Replication Study Baseline-Attachment G Survey Part B2 non-sexually active 5.17.12.doc		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,138	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	2,138	2,138
Annual IC Time Burden (Hours)	535	535
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.