Media-Smart Youth® Teen Leaders Program: Advisor Satisfaction Survey (Indiv-HH)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Media-Smart Youth® Teen Leaders Program: Advisor Satisfaction Survey (Indiv-HH) Form and Instruction
1 MSY Teen Leaders Advisor Final Survey 0925-0643_MSY Teen Leaders_Advisor Final Survey.pdf Form and Instruction
0925-0643_clearance_template_MSY Teen Leaders_Advisor_Indiv-HH.doc Fast-Track Template Submission Form IC Document

Information Collection (IC) Details

IC Title:	Media-Smart Youth® Teen Leaders Program: Advisor Satisfaction Survey (Indiv-HH)	Agency IC Tracking Number:

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 and Instruction	1	MSY Teen Leaders Advisor Final Survey	0925-0643_MSY Teen Leaders_Advisor Final Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	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	13	13
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast-Track Template Submission Form	0925-0643_clearance_template_MSY Teen Leaders_Advisor_Indiv-HH.doc	02/18/2015

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