Information Collection

Youth Baseline Questionnaire (Experimenter and Non-Trier)

IC 208708 under ICR 201309-0910-006 · OMB 0910-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0753 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2_Youth Baseline and Follow-up Instruments_10_15_13_tracked changes.doc	Instruction
Attachment 2a_Rationale for Outcome Evaluation Measures.docx	Instruction
Attachment 5_Incentives_tracked changes.doc	Instruction
Attachment 6_Permission Assent Consent_tracked changes.doc	Instruction
Attachment 7_Introduction to Study_tracked changes.doc	Instruction
Attachment 8_Study Description_tracked changes.doc	Instruction
Attachment 9_Privacy and Data Security.doc	Instruction
Attachment 10_Baseline Parent Lead Letter_tracked changes.doc	Instruction
Attachment 11_Questions and Answers about the ExPECTT Evaluation_tracked changes.doc	Instruction
Attachment 12_Telephone Verification Survey_tracked changes.doc	Other-Survey
Attachment 13_Notifications_tracked changes.doc	Instruction

IC Title:

Youth Baseline Questionnaire (Experimenter and Non-Trier)

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Attachment 7_Introduction to Study_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 8_Study Description_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 9_Privacy and Data Security.doc	Yes	No	Printable Only
Instruction	Attachment 10_Baseline Parent Lead Letter_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 11_Questions and Answers about the ExPECTT Evaluation_tracked changes.doc	Yes	No	Printable Only
Other-Survey	Attachment 12_Telephone Verification Survey_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 2_Youth Baseline and Follow-up Instruments_10_15_13_tracked changes.doc	Yes	No	Fillable Printable
Instruction	Attachment 2a_Rationale for Outcome Evaluation Measures.docx	Yes	No	Printable Only
Instruction	Attachment 5_Incentives_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 6_Permission Assent Consent_tracked changes.doc	Yes	No	Printable Only
Instruction	Attachment 13_Notifications_tracked changes.doc	Yes	No	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,686

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,686	2,686
Annual IC Time Burden (Hours)	1,343	1,343
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.