Parent Outcome Baseline Survey

Evaluation of Dating Matters: Strategies to Promote Healthy Teen Relationships

Documents and Forms

Document Name Document Type
Parent Outcome Baseline Survey Form and Instruction
Parent/Guardian Survey Attachment H - Educator+Outcome+Survey.docx Form and Instruction
Atmt VV Parent Program Participant Consent Form.docx Atmt VV Parent Program Participant Consent Form IC Document

Information Collection (IC) Details

IC Title:	Parent Outcome Baseline Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 and Instruction	none	Parent/Guardian Survey	Attachment H - Educator+Outcome+Survey.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,919	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,919	1,919
Annual IC Time Burden (Hours)	-1,919	1,919
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Atmt VV Parent Program Participant Consent Form	Atmt VV Parent Program Participant Consent Form.docx	02/27/2012

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