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Federal forms, ICRs, and supporting documents

Information Collection

Youth Baseline Questionnaire (Male Rural Smokeless)

IC 208710 under ICR 201502-0910-009 · OMB 0910-0753.

Documents and Forms
Document Name
Document Type
Other-Email reminder #1
Other-E-mail reminder #2
Other-E-mail reminder #3
Other-Parent permission
Other-Youth Assent
Other-Media Tracking Screener and In
Other-Rationale for Item Changes to
Information Collection (IC) Details

View Information Collection (IC)

Youth Baseline Questionnaire (Male Rural Smokeless)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Email reminder #1 5 Email_reminder1_ 0910-0753.doc Yes No Printable Only
Other-E-mail reminder #2 6 Email_reminder2_ 0910-0753.doc Yes No Printable Only
Other-E-mail reminder #3 7 Email_reminder3_ 0910-0753.doc Yes No Printable Only
Other-Parent permission 8 Attachment 6_Parent Permission 0910-0753.doc Yes No Printable Only
Other-Youth Assent 9 Attachment 6_Youth Assent 0910-0753.doc Yes No Printable Only
Other-Media Tracking Screener and Instrument 12 Attachment 4_Media Tracking Screener and Instrument 0910-0753.doc Yes No Printable Only
Other-Rationale for Item Changes to Media Tracking Instrument 13 Rationale for Item Changes to the ExPECTT Media Tracking Instrument 0901-0753.docx Yes No Printable Only

Health Immunization Management

 

656 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 656 0 0 0 0 656
Annual IC Time Burden (Hours) 328 0 0 0 0 328
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.