Information Collection

Formative Research on Resilience and Transgender Youth

IC 223954 under ICR 201511-0920-001 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Formative Research on Resilience and Transgender Youth	Form and Instruction
Qualitative Interview Guide Att 3 Qualitative InDepth Interview Guide.docx	Form and Instruction
Eligibility Screener Att 6 Eligibility Screener.docx	Form and Instruction
Att 1-Section 301 of the PHSA.PDF Authorizing Legislation	IC Document
Att 2 60 Day FRN.PDF 60-day FRN for the Generic	IC Document
Att 4a Consent Form(Age 18+).docx Consent Form for Ages 18+	IC Document
Att 4b Assent Form(Age 15-17).docx Assent Form for Ages 15-17	IC Document
Att 5-Recruitment Flyer and Palmcard Text.docx Recruitment Flyer and Palmcard Text	IC Document
Att 7- Interviewer Form.docx Interviewer Form (for staff use only)	IC Document
Att 8-Memorandum of Understanding with CBOs.docx MOU with Community Based Organizations	IC Document
Att 9- Atlanta Metro Resources.docx Atlanta Metro Resources	IC Document
Att 10 IRB Approvals CDCICF.DOCX IRB Documentation for CDC and ICF	IC Document
SSA_10 14 2016.docx Supporting Statement A	IC Document
SSB_10 14 2016.docx Supporting Statement B	IC Document

IC Title:

Formative Research on Resilience and Transgender Youth

Agency IC Tracking Number:

0920-16BFO

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	N/A	Qualitative Interview Guide	Att 3 Qualitative InDepth Interview Guide.docx		No		Paper Only
Form and Instruction	N/A	Eligibility Screener	Att 6 Eligibility Screener.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 252

Number of Respondents: 48

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation	Att 1-Section 301 of the PHSA.PDF	10/14/2016
60-day FRN for the Generic	Att 2 60 Day FRN.PDF	10/14/2016
Consent Form for Ages 18+	Att 4a Consent Form(Age 18+).docx	10/14/2016
Assent Form for Ages 15-17	Att 4b Assent Form(Age 15-17).docx	10/14/2016
Recruitment Flyer and Palmcard Text	Att 5-Recruitment Flyer and Palmcard Text.docx	10/14/2016
Interviewer Form (for staff use only)	Att 7- Interviewer Form.docx	10/14/2016
MOU with Community Based Organizations	Att 8-Memorandum of Understanding with CBOs.docx	10/14/2016
Atlanta Metro Resources	Att 9- Atlanta Metro Resources.docx	10/14/2016
IRB Documentation for CDC and ICF	Att 10 IRB Approvals CDCICF.DOCX	10/14/2016
Supporting Statement A	SSA_10 14 2016.docx	10/14/2016
Supporting Statement B	SSB_10 14 2016.docx	10/14/2016

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