Information Collection

2018 NLM SIS Emerging Adults Health Needs Assessment

IC 230502 under ICR 201501-0925-004 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2018 NLM SIS Emerging Adults Health Needs Assessment	Form and Instruction
1 SIS Emerging Adults Focus Group survey instrument SIS Emerging Adults Focus Group Survey Instrument.docx	Form and Instruction
2 SIS Emerging Adults Web Based Survey instrument SIS Emerging Adults Web Based Survey Instrument (screen shots).pdf	Form
NLM Fast track_2018 NLM SIS Emerging Adults Health Needs Assessment.doc 2018 NLM SIS Emerging Adults Health Needs Assessment	IC Document

IC Title:

2018 NLM SIS Emerging Adults Health Needs Assessment

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	SIS Emerging Adults Focus Group survey instrument	SIS Emerging Adults Focus Group Survey Instrument.docx		No		Paper Only
Form	2	SIS Emerging Adults Web Based Survey instrument	SIS Emerging Adults Web Based Survey Instrument (screen shots).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 127

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	127	127
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2018 NLM SIS Emerging Adults Health Needs Assessment	NLM Fast track_2018 NLM SIS Emerging Adults Health Needs Assessment.doc	03/06/2018

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