Information Collection

Adolescents with Additional Assesments

IC 190912 under ICR 201211-0925-007 · OMB 0925-0610.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0610 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 9 Adolescents with Additional Assesments	Form and Instruction
9 survey Attach 9	Form and Instruction
10 survey Attach 10	Form and Instruction

IC Title:

Adolescents with Additional Assesments

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	9	survey	Attach 9		Yes	Yes	Paper Only
Form and Instruction	10	survey	Attach 10		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-750	750
Annual IC Time Burden (Hours)	-1,875	1,875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.