Information Collection

Adolescent Pretest & Main data collection

IC 228331 under ICR 201708-0910-011 · OMB 0910-0848.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix F_GWL Instrument.docx	Other-Study Instrument
Stimuli.pdf	Other-Stimuli

IC Title:

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
Other-Study Instrument			Appendix F_GWL Instrument.docx		Yes	Yes	Fillable Fileable
Other-Stimuli			Stimuli.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 865

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	865	865
Annual IC Time Burden (Hours)	216	216
Annual IC Cost Burden (Dollars)	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.