Information Collection

PATH - Adults - Followup/Tracking Participant Information Form for Youth(completed ny Parents)/Field Test

IC 203772 under ICR 201208-0925-002 · OMB 0925-0664.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0664 can be found here:

Documents and Forms

Document Name Document Type
Form 2i PATH - Adults - Followup/Tracking Participant Information Form for Youth(completed ny Parents)/Field Test Form
2i Followup/Tracking Youth 2i. Followup_Tracking_Participant_Info_Forms_Youth.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PATH - Adults - Followup/Tracking Participant Information Form for Youth(completed ny Parents)/Field Test	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
Form	2i	Followup/Tracking Youth	2i. Followup_Tracking_Participant_Info_Forms_Youth.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: NIH Privacy Act System of Records 09-25-0200 Clinical, Basic, Population-based research studies of NIH, HHS/NIH/OD	FR Citation: 67 FR 60741

Number of Respondents: 100	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	200	200
Annual IC Time Burden (Hours)	27	27
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.