Information Collection

Youth Screener and Consent for Online Outcome Survey

IC 215947 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⚠️ Notice: This information collection may be referencing outdated material.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 5c_Parental Permission_Youth Assent_Longitudinal Age 12-17_Web.docx	Other-Longitudinal Web Consent and A
Attachment 5d_Informed Consent_Longitudinal Age 18_Web.docx	Other-Longitudinal Web Consent 18+ Y
Attachment 3_Outcome Web Screener.docx	Other-Outcome Web Screener
Attachment 5e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web.docx	Other-Cross Sectional Social Media_S
Attachment 5f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_Web.docx	Other-Youth Assent Cross Sectional A
Attachment 5g_Youth Assent_Longitudinal Age 13 - 17_Social Media_Web.docx	Other-Youth Assent Longitudinal Age
Attachment 5i_Youth Assent_Longitudinal Age 15 - 17_Social Media_Permission Waived_Web.docx	Other-Youth Assent Longitudinal Age
Attachment 3_Outcome Web Screener.docx	Other-Outcome Web Screener

IC Title:

Youth Screener and Consent for Online 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-Longitudinal Web Consent and Assent	Attachment 5c_Parental Permission_Youth Assent_Longitudinal Age 12-17_Web.docx	Yes	Yes	Printable Only
Other-Longitudinal Web Consent 18+ Year Old Youth	Attachment 5d_Informed Consent_Longitudinal Age 18_Web.docx	Yes	Yes	Printable Only
Other-Youth Assent Longitudinal Age 13 - 17 Social Media Web	Attachment 5g_Youth Assent_Longitudinal Age 13 - 17_Social Media_Web.docx	Yes	Yes	Fillable Fileable
Other-Youth Assent Longitudinal Age 15 - 17 Social Media Permission Waived Web	Attachment 5i_Youth Assent_Longitudinal Age 15 - 17_Social Media_Permission Waived_Web.docx	Yes	Yes	Fillable Fileable
Other-Outcome Web Screener	Attachment 3_Outcome Web Screener.docx	Yes	Yes	Fillable Fileable
Other-Youth Assent Cross Sectional Age 13 - 14 Social Media Web	Attachment 5f_Youth Assent_Cross Sectional Age 13 - 14_Social Media_Web.docx	Yes	Yes	Fillable Fileable
Other-Outcome Web Screener	Attachment 3_Outcome Web Screener.docx	Yes	Yes	Fillable Fileable
Other-Cross Sectional Social Media_Snowball 15+ Youth	Attachment 5e_Youth Assent_Cross Sectional Age 15 - 17_Social Media_Web.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32,000

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	32,000	-7,000	39,000
Annual IC Time Burden (Hours)	2,666	-583	3,249
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.