Information Collection

Pre- and Post-Youth Survey

IC 225433 under ICR 201701-0930-004 · OMB 0930-0373.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0373 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Youth Pre-test Pos Pre- and Post-Youth Survey	Form and Instruction
Youth Pre-test Pos Youth Pre-test Post-test Survey 3_Youth Pre-test Post-test Survey_January 20 2017.docx	Form and Instruction
4_Youth Survey Parent Permission and Opt-Out Forms_January 20 2017.docx Youth Survey Parent Permission and Opt-Out Forms	IC Document

IC Title:

Pre- and Post-Youth Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Youth Pre-test Post-test Survey	Youth Pre-test Post-test Survey	3_Youth Pre-test Post-test Survey_January 20 2017.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,093

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,186	2,186
Annual IC Time Burden (Hours)	372	372
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Youth Survey Parent Permission and Opt-Out Forms	4_Youth Survey Parent Permission and Opt-Out Forms_January 20 2017.docx	01/30/2017

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