Information Collection

2017-2019 Youth Risk Behavior Survey

IC 6930 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⚠️ Notice: This information collection may be referencing outdated material.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 Youth Risk Behavior Survey	Form and Instruction
Youth Risk Behavior Questionnaire 2017 - 2019 App J_YRB Survey Questionnaire.docx	Form and Instruction
Appx D - Rationale for Survey Questions.docx Appx D - Rationale for Survey Questions	IC Document
Appx F - YRBS Questionnaire - supplemental documents.doc Appx F - YRBS Questionnaire - supplemental documents	IC Document

IC Title:

2017-2019 Youth Risk Behavior Survey

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	Youth Risk Behavior Questionnaire 2017 - 2019	App J_YRB Survey Questionnaire.docx	NA	No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,129

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	10,129	10,129
Annual IC Time Burden (Hours)	7,597	7,597
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appx D - Rationale for Survey Questions	Appx D - Rationale for Survey Questions.docx	07/16/2012
Appx F - YRBS Questionnaire - supplemental documents	Appx F - YRBS Questionnaire - supplemental documents.doc	07/16/2012

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