Information Collection

Youth Mail Screener and Consent Process for Outcome Survey

IC 215941 under ICR 201603-0910-010 · OMB 0910-0788.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0788 can be found here:

Documents and Forms

Document Name Document Type
Attachment 2_Outcome Mail Screener.docx Other-Outcome Mail Screener
Attachment 5_Informed Consent and Assent.docx Other-Informed Consent and Assent
Attachment 5d_Longitudinal Web Consent 18+ Year Old Youth.docx Other-Longitudinal Web Consent 18+ Y
Attachment 5a_Longitudinal Informed Consent and Assent.docx Other-Longitudinal Informed Consent

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Youth Mail Screener and Consent Process for Outcome Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Outcome Mail Screener	Attachment 2_Outcome Mail Screener.docx	No		Paper Only
Other-Informed Consent and Assent	Attachment 5_Informed Consent and Assent.docx	No		Printable Only
Other-Longitudinal Web Consent 18+ Year Old Youth	Attachment 5d_Longitudinal Web Consent 18+ Year Old Youth.docx	Yes	Yes	Fillable Printable
Other-Longitudinal Informed Consent and Assent	Attachment 5a_Longitudinal Informed Consent and Assent.docx	No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28,324	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	28,324	14,508	13,816
Annual IC Time Burden (Hours)	2,360	1,209	1,151
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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