Information Collection

LGBT young adults outcome baseline (social media)

IC 218385 under ICR 201810-0910-015 · OMB 0910-0808.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 06a New Participant Survey Informed Consent_FU6.docx	Other-New Participant Informed Conse
Attachment 1_BaselineWebSurvey.docx	Other-Baseline Web Survey

IC Title:

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-New Participant Informed Consent			Attachment 06a New Participant Survey Informed Consent_FU6.docx		Yes	Yes	Fillable Fileable
Other-Baseline Web Survey			Attachment 1_BaselineWebSurvey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 263

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	263	0	263
Annual IC Time Burden (Hours)	132	1	131
Annual IC Cost Burden (Dollars)	0	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.