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Adult Follow-up - Screenshot
Web-based Media Literacy Parent Training for Substance Use Prevention in Rural Locations
OMB: 0925-0685
IC ID: 209242
OMB.report
HHS/NIH
OMB 0925-0685
ICR 201502-0925-002
IC 209242
( )
Documents and Forms
Document Name
Document Type
Form 5
Adult Follow-up - Screenshot
Form
5 Adult Follow-up
Attachment 22 - Screenshot Adult Followup - MDF.zip
Form
Attachment_5_-_Data_collection_instrument_-_Adult_questionnaire_Followup_MDF[1].pdf
Adult Follow-up
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Adult Follow-up - Screenshot
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
5
Adult Follow-up
Attachment 22 - Screenshot Adult Followup - MDF.zip
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
SORN 09-25-0200
FR Citation:
67 FR 60741
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
200
0
0
0
0
200
Annual IC Time Burden (Hours)
150
0
0
0
0
150
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Adult Follow-up
Attachment_5_-_Data_collection_instrument_-_Adult_questionnaire_Followup_MDF[1].pdf
11/06/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
