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24 month Followup survey California and Texas
Pregnancy Assistance Fund Feasibility And Design Study(Positive Adolescent Futures)
OMB: 0990-0424
IC ID: 223049
OMB.report
HHS/HHSDM
OMB 0990-0424
ICR 201604-0990-002
IC 223049
( )
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
View Information Collection (IC)
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
Federal Enterprise Architecture Business Reference Module
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 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
505
0
505
0
0
0
Annual IC Time Burden (Hours)
253
0
253
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.