Information Collection

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

IC 203772 under ICR 201309-0925-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1 PATH - Adults - Followup/Tracking Participant Information Form for Shadow Sample Youth(completed ny Parents)/Field Test	Form and Instruction
1 Shadow Sample 3j-English. Followup Tracking Participant Information Form - Shadow Sample Youth 050813.pdf	Form and Instruction
3j-Spanish. Followup Tracking Participant Information Form - Shadow Sample Youth.pdf 3j-Spanish	IC Document

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	1	Shadow Sample	3j-English. Followup Tracking Participant Information Form - Shadow Sample Youth 050813.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: 16,186

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	32,372	32,372
Annual IC Time Burden (Hours)	4,316	4,316
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
3j-Spanish	3j-Spanish. Followup Tracking Participant Information Form - Shadow Sample Youth.pdf	06/28/2013

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