Information Collection

Youth Mail Screener and Consent Process for Outcome Survey

IC 215941 under ICR 201708-0910-012 · 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⚠️ Notice: This information collection may be referencing outdated material.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 2_Outcome Mail Screener.docx	Other-Outcome Mail Screener
Attachment 5_Informed Consent and Assent.docx	Other-Informed Consent and Assent
Attachment 5d_Informed Consent_Longitudinal Age 18_Web_FU3.docx	Other-Longitudinal Web Consent 18+ Y
Attachment 5a_Parental Permission_Youth Assent_Longitudinal Age 12- 17_Household_FU3.docx	Other-Longitudinal Informed Consent
Attachment 5b_Informed Consent_Longitudinal Age 18_Household_FU3.docx	Other-Informed Consent Longitudinal

IC Title:

Youth Mail Screener and Consent Process for 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-Outcome Mail Screener	Attachment 2_Outcome Mail Screener.docx	No		Paper Only
Other-Informed Consent and Assent	Attachment 5_Informed Consent and Assent.docx	No		Printable Only
Other-Longitudinal Web Consent 18+ Year Old Youth	Attachment 5d_Informed Consent_Longitudinal Age 18_Web_FU3.docx	Yes	Yes	Fillable Printable
Other-Longitudinal Informed Consent and Assent	Attachment 5a_Parental Permission_Youth Assent_Longitudinal Age 12- 17_Household_FU3.docx	No		Printable Only
Other-Informed Consent Longitudinal Age 18 Household	Attachment 5b_Informed Consent_Longitudinal Age 18_Household_FU3.docx	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,816

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	Previously Approved
Annual Number of Responses for this IC	13,816	13,816
Annual IC Time Burden (Hours)	1,151	1,151
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.