YSI Program Users (Post-Use Survey)

Evaluation of the Young Sisters Initiative: A Guide to A Better You! Program

Documents and Forms

Document Name Document Type
YSI Program Users (Post-Use Survey) Form
Post-Use Survey Screenshots Att 5A_YSI Program Post-Use Survey_9 17 2012.pdf Form
Att 5B_Full Version YSI Program Post-Use Survey_ 9 17 2012.docx Word Version - Post-Use Survey IC Document

Information Collection (IC) Details

IC Title:	YSI Program Users (Post-Use Survey)	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	none	Post-Use Survey Screenshots	Att 5A_YSI Program Post-Use Survey_9 17 2012.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Word Version - Post-Use Survey	Att 5B_Full Version YSI Program Post-Use Survey_ 9 17 2012.docx	09/27/2012

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