Information Collection

Media-Smart Youth® Teen Leaders Program: Midpoint Program Satisfaction Survey for Teen Leaders

IC 215115 under ICR 201410-0925-002 · OMB 0925-0643.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Media-Smart Youth® Teen Leaders Program: Midpoint Program Satisfaction Survey for Teen Leaders	Form and Instruction
1 MSY Teen Leaders_Midpoint Survey 0925-0643_MSY Teen Leaders_Teen Leaders Midpoint Survey.pdf	Form and Instruction
0925-0643_clearance_template_MSY Teen Leaders_Midpoint.doc Fast-Track Template Submission Form	IC Document

IC Title:

Media-Smart YouthÂ® Teen Leaders Program: Midpoint Program Satisfaction Survey for Teen Leaders

Agency IC Tracking Number:

IC Status: New

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	MSY Teen Leaders_Midpoint Survey	0925-0643_MSY Teen Leaders_Teen Leaders Midpoint 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: 59

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	59	59
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast-Track Template Submission Form	0925-0643_clearance_template_MSY Teen Leaders_Midpoint.doc	02/19/2015

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