Information Collection

Longitudinal Cohort Youth Post-Test Outcome Survey

IC 215944 under ICR 201701-0910-001 · OMB 0910-0788.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0788 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 1_Post Campaign Instrument.docx	Other-Post Campaign Instrument.
Attachment 8a_Outcome Parent Lead Letter Longitudinal.docx	Other-Outcome Parent Lead Letter Lon
Attachment 10_Parent Second Mailing.docx	Other-Parent Second Mailing
Attachment 13_Unable to Contact Letters.docx	Other-Unable to Contact Letters
Attachment 17_Verification Call Script.docx	Other-Verification Call Script

IC Title:

Longitudinal Cohort Youth Post-Test Outcome 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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Post Campaign Instrument.	Attachment 1_Post Campaign Instrument.docx	Yes	Yes	Fillable Fileable
Other-Outcome Parent Lead Letter Longitudinal	Attachment 8a_Outcome Parent Lead Letter Longitudinal.docx	No		Paper Only
Other-Parent Second Mailing	Attachment 10_Parent Second Mailing.docx	No		Paper Only
Other-Unable to Contact Letters	Attachment 13_Unable to Contact Letters.docx	No		Paper Only
Other-Verification Call Script	Attachment 17_Verification Call Script.docx	No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,452

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,452	357	4,095
Annual IC Time Burden (Hours)	3,340	268	3,072
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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