Parent Outcome Baseline Survey

Evaluation of Dating Matters: Strategies to Promote Healthy Teen Relationships

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0941 can be found here:

Documents and Forms

Document Name Document Type
Parent Outcome Baseline Survey Form and Instruction
Parent Outcome Baseline Survey Atmt_H_Parent_Outcome_Survey_Baseline[1].doc Form and Instruction
Atmt VV Parent Program Participant Consent Form.docx Atmt VV Parent Program Participant Consent Form IC Document
Atmt SSS Screen shots parent survey_11-22-11 BT.doc Atmt SSS Screen shots parent survey_11-22-11 BT IC Document

Information Collection (IC) Details

IC Title:	Parent Outcome Baseline Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	None	Parent Outcome Baseline Survey	Atmt_H_Parent_Outcome_Survey_Baseline[1].doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,919	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	Previously Approved
Annual Number of Responses for this IC	1,919	-505	2,424
Annual IC Time Burden (Hours)	1,919	-505	2,424
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Atmt VV Parent Program Participant Consent Form	Atmt VV Parent Program Participant Consent Form.docx	02/27/2012
Atmt SSS Screen shots parent survey_11-22-11 BT	Atmt SSS Screen shots parent survey_11-22-11 BT.doc	02/27/2012

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