Information Collection

2017-2019 Data Collection Checklist

IC 184922 under ICR 201605-0920-018 · OMB 0920-0493.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0493 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2017-2019 Data Collection Checklist	Form and Instruction
Data Collection Checklist for YRBS App F_Data Collection Checklist.docx	Form and Instruction
Appx J - Data Collection Checklist YRBS - supplemental docs.doc Appx J - Data Collection Checklist YRBS - supplemental docs	IC Document

IC Title:

2017-2019 Data Collection Checklist

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
Form and Instruction	NA	Data Collection Checklist for YRBS	App F_Data Collection Checklist.docx	NA	No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 435

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
Annual Number of Responses for this IC	435	435
Annual IC Time Burden (Hours)	109	109
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appx J - Data Collection Checklist YRBS - supplemental docs	Appx J - Data Collection Checklist YRBS - supplemental docs.doc	07/16/2012

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