Information Collection

Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]

IC 248018 under ICR 201807-0920-004 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

2026-07-06 - Reinstatement without change of a previously approved collection
2025-05-01 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Telephone Screening Script (for Target Respondents) Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction
Telephone Screening Script (for Parent / Guardian) Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction
Questions to be Cognitively Tested Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction
Respondent Data Collection Sheet Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction
Follow-up Debriefing Discussion Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]	Form and Instruction
Attachment 1 - Procedures for Cognitive Testing of Occupational Safety and Health Questions for the YRBSS CLEAN Revised.docx	Other-Virtual Interview Setup Suppor
Telephone Screening Script (for Target Respondents) Attachment 4 Telephone Screening Script CLEAN - Revised.docx	Form and Instruction
Telephone Screening Script (for Parent / Guardian) Attachment 4 Telephone Screening Script CLEAN - Revised.docx	Form and Instruction
Questions to be Cognitively Tested Attachment 2- Questions to be Cognitively Tested CLEAN Revised.docx	Form and Instruction
Respondent Data Collection Sheet Attachment 6 -Adult Data Collection Sheet .docx	Form and Instruction
Follow-up Debriefing Discussion Attachment 8 Follow-up Discussion_.docx	Form and Instruction
Attachment 1 - Procedures for Cognitive Testing of Occupational Safety and Health Questions for the YRBSS CLEAN Revised.docx Procedures for Cognitive Testing of Occupational Health and Safety Questions for YRBSS	IC Document
Attachment 3a-3d LettersAdFlyer_vcb042021 .docx Recruitment Materials	IC Document
Attachment 5a-5f Informed Consent CLEAN.docx Informed Consent Materials - Youth Assent and Parent/Guardian Permission	IC Document
Attachment 7 – Thank You Letter.docx Thank You Letter	IC Document
Attachment 9 - Distress guidance.docx Guidance to Interviewers: Identifying, Managing, and Reporting Respondent Distress	IC Document
10-day letter-virtual Occupational Safety and Health Questions for the YRBSS Revised CLEAN July 29 2021.docx 10 day letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]

Agency IC Tracking Number:

0920-21FZ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable
Other-Virtual Interview Setup Support [see Sections III and IV]		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164, Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	71	71
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Procedures for Cognitive Testing of Occupational Health and Safety Questions for YRBSS		06/23/2021
Recruitment Materials		06/23/2021
Informed Consent Materials - Youth Assent and Parent/Guardian Permission		06/23/2021
Thank You Letter		06/23/2021
Guidance to Interviewers: Identifying, Managing, and Reporting Respondent Distress		06/23/2021
10 day letter		07/31/2021

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].