Information Collection

Young Persons

IC 203609 under ICR 201208-0930-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Young Person Instr Young Persons	Form and Instruction
Young Person Instr Young Person Instruments Young Person Instruments_Attachments C,E,J,K.pdf	Form and Instruction
Other.pdf Other	IC Document
Healthy Transitions Grant Application RFA_Attachment A.pdf RFA	IC Document
Consent Forms_Attachments M,N.pdf Consent Forms	IC Document

IC Title:

Young Persons

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
Form and Instruction	Young Person Instruments	Young Person Instruments	Young Person Instruments_Attachments C,E,J,K.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	796	796
Annual IC Time Burden (Hours)	547	547
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Other	Other.pdf	08/06/2012
RFA	Healthy Transitions Grant Application RFA_Attachment A.pdf	08/06/2012
Consent Forms	Consent Forms_Attachments M,N.pdf	08/06/2012

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