Information Collection

Adolescent -Pretest

IC 234612 under ICR 201812-0910-008 · OMB 0910-0866.

Documents and Forms

IC Title:

Adolescent -Pretest

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Session 1 Survey	Session 1 Survey.docx	Yes	Yes	Fillable Fileable Signable
Other-Session 2 Survey	Session 2 Survey.docx	Yes	Yes	Fillable Fileable Signable
Other-Session 3 Survey	Session 3 Survey.docx	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	6	6
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.