Information Collection

Youth Pre-Test – Outcome Survey

IC 215943 under ICR 201901-0910-003 · OMB 0910-0788.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 01_EFECT_Post_Campaign_Instrument_FU5.docx	Other-Post Campaign Instrument
Attachment 17_Verification Call Script_Age 13-17_FU5.docx	Other-Verification Call Script

IC Title:

Youth Pre-Test â 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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Post Campaign Instrument			Attachment 01_EFECT_Post_Campaign_Instrument_FU5.docx		Yes	Yes	Fillable Printable
Other-Verification Call Script			Attachment 17_Verification Call Script_Age 13-17_FU5.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,194

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	2,194	2,194
Annual IC Time Burden (Hours)	1,097	1,097
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.