Information Collection

Cross-Sectional Cohort Youth Post-Test Outcome Survey

IC 215945 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Attachment 1_ Post Campaign Instrument.docx	Other-Post Campaign Instrument
Attachment 17_Verification Call Script.docx	Other-Verification Call Script

IC Title:

Cross-Sectional Cohort Youth Post-Test Outcome Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Post Campaign Instrument			Attachment 1_ Post Campaign Instrument.docx		Yes	Yes	Fillable Fileable
Other-Verification Call Script			Attachment 17_Verification Call Script.docx		No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,205

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	Previously Approved
Annual Number of Responses for this IC	2,205	105	2,100
Annual IC Time Burden (Hours)	1,653	603	1,050
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.