Att 3_Sample Instrument: Youth Questionnaire

Assessments to Inform Program Refinement for HIV, other STD, and Pregnancy Prevention among Middle and High-School Aged Youth

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1235 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-xxxx Att 3_Sample Instrument: Youth Questionnaire Form and Instruction
0920-xxxx Sample Instrument: Youth Questionnaire Att 3-Sample Instrument-Youth Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Att 3_Sample Instrument: Youth Questionnaire	Agency IC Tracking Number:	0920-18AF

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-xxxx	Sample Instrument: Youth Questionnaire	Att 3-Sample Instrument-Youth Questionnaire.docx		No		Fillable Fileable Signable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	16,667	16,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.