Media-Smart Youth® Teen Leaders Program: Nonprofit Partner Satisfaction Survey

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⚠️ Notice: This information collection may be referencing outdated material.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: Nonprofit Partner Satisfaction Survey Form and Instruction
1 MSY Teen Leaders Nonprofit Partner Final Survey 0925-0643_MSY Teen Leaders_Nonprofit Partner Final Survey.pdf Form and Instruction
0925-0643_clearance_template_MSY Teen Leaders_Nonprofit Partner.doc Fast-Track Template Submission Form IC Document

Information Collection (IC) Details

IC Title:	Media-Smart Youth® Teen Leaders Program: Nonprofit Partner Satisfaction Survey	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 Nonprofit Partner Final Survey	0925-0643_MSY Teen Leaders_Nonprofit Partner 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: 59	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	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

Title	Document	Date Uploaded
Fast-Track Template Submission Form	0925-0643_clearance_template_MSY Teen Leaders_Nonprofit Partner.doc	02/19/2015

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