OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Media Tracking Questionnaires 1st, 2nd and; 3rd

IC 208714 under ICR 201506-0910-029 · OMB 0910-0753.

Documents and Forms
Document Name
Document Type
Other-Media Tracking Screener and In
Other-Rationale for Item Changes to
Other-Youth Follow up Instrument
Other-Rational for Item Changes to t
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Media Tracking Questionnaires 1st, 2nd and; 3rd
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
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
Other-Youth Follow up Instrument 10 Attachment 2_Youth Follow-up Instrument 0910-0753.doc Yes No Printable Only
Other-Rational for Item Changes to the Follow up Instrument 11 Rationale for Item Changes to the Follow Up Instrument 0910-0753.docx Yes No Printable Only

Health Immunization Management

 

3,999 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 3,999 0 0 0 0 3,999
Annual IC Time Burden (Hours) 2,001 0 0 0 0 2,001
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Contents of change request 0 Contents of OMB Change Request for ExPECTT Second Follow Up.doc 03/04/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.