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Baseline Survey of impact study participants

IC 212078 under ICR 201604-0990-002 · OMB 0990-0424.

Documents and Forms
Document Name
Document Type
Other-baseline survey
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Baseline 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-baseline survey 0990-0424Attachment G_PAF Follow up Pretest Memorandum.docx Yes Yes Fillable Printable

Health Health Care Services

 

673 0
   
Individuals or Households
 
   90 %

  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 673 0 0 0 0 673
Annual IC Time Burden (Hours) 337 0 0 0 0 337
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment G Baseline Pretest Memo 0990_Attachment G_Baseline Pretest Memo.pdf 06/25/2014
Attachment I Person Consulted on Instrument 0990_Attachment I_Persons Consulted.docx 06/25/2014
Attachment K Confidential Pledge 0990-Attachment K_Confidentiality Pledge.pdf 06/25/2014
Attachment M Overview For Grantees 0990-Attachment M_Overview for Grantees.pdf 06/25/2014
Consent Letters and Forms, Youth Assent Form, and Contact Information Sheet 0990-Attachment J_PAF_Consent Letters and Forms and Youth Assent Form_08262014.docx 08/29/2014
Analysis Plan for PAF Impact Study 0990-Attachment L_PAF Analysis Plan for Impact Study_revised.docx 08/29/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.