12 Month follow-up survey of impact study participants

Pregnancy Assistance Fund Feasibility And Design Study(Positive Adolescent Futures)

OMB: 0990-0424

IC ID: 212904

Information Collection (IC) Details

View Information Collection (IC)

12 Month follow-up survey of impact study participants
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 0990-424 Instrument 1 - CA Followup Survey.docx Yes Yes Fillable Fileable
Other-survey 0990-0424 Instrument 2 - TX Followup Survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

572 0
   
Individuals or Households
 
   40 %

  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 572 0 571 0 0 1
Annual IC Time Burden (Hours) 334 0 334 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Overview of the PAF Evaluation 0990-0424 Attachment A_ Overview of the PAF Evaluation_FU.docx 07/21/2015
Question by Question Source List for the Follow up Survey 0990-0424 Attachment B_Question by Question Source Table for the PAF Follow Up.docx 07/21/2015
Sources Referenced for the Follow-up Survey 0990-0424 Attachment C_Sources Referenced for PAF Follow Up.docx 07/21/2015
Persons Consulted on Instrument Development and or Analysis of the PAF Follow-up Survey 0990-0424 Attachment D_Persons Consulted.docx 07/21/2015
Confidential Pledge 0990-0424 Attachment E_Confidentiality Pledge PAF FU.pdf 07/21/2015
Analysis Plan 0990-0424 Attachment F_PAF Analysis Plan for Impact Study_FU.docx 07/21/2015
Pretest Memo 0990-0424 Attachment G_PAF Follow up Pretest Memorandum.docx 07/21/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy