2017-2019 Data Collection Checklist

2017 and 2019 Youth Risk Behavior Surveys

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.