24 month Followup survey California and Texas

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

Documents and Forms

Document Name Document Type
Instrument 1- CA_24 Month Followup Survey.docx Other-survey
Instrument 2- TX_24 Month Followup Survey.docx Other-survey
Attachment A_ Overview of the PAF Evaluation_FU.docx Overview of the PAF IC Document
Attachment B_Question by Question Source Table for the PAF Follow Up.docx Source Table IC Document
Attachment C_Sources Referenced for PAF Follow Up.docx Sources Referenced IC Document
Attachment D_Persons Consulted.docx Person Consulted IC Document
Attachment F_PAF Analysis Plan for Impact Study_FU.docx PAF Analysis Plan IC Document

Information Collection (IC) Details

IC Title:	24 month Followup survey California and Texas	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-survey			Instrument 1- CA_24 Month Followup Survey.docx		Yes	Yes	Fillable Fileable
Other-survey			Instrument 2- TX_24 Month Followup Survey.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 505	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
Annual Number of Responses for this IC	505	505
Annual IC Time Burden (Hours)	253	253
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Overview of the PAF	Attachment A_ Overview of the PAF Evaluation_FU.docx	08/16/2016
Source Table	Attachment B_Question by Question Source Table for the PAF Follow Up.docx	08/16/2016
Sources Referenced	Attachment C_Sources Referenced for PAF Follow Up.docx	08/16/2016
Person Consulted	Attachment D_Persons Consulted.docx	08/16/2016
PAF Analysis Plan	Attachment F_PAF Analysis Plan for Impact Study_FU.docx	08/16/2016

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