Information Collection

Pre- and Post-Youth Survey

IC 225433 under ICR 201912-0930-005 · OMB 0930-0373.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Pre- and Post-Yout Pre- and Post-Youth Survey	Form and Instruction
Pre- and Post-Yout Pre- and Post-Youth Survey Attachment_3_Youth Pre-test Post-test Survey_OMB-0930-0373_12.4.19.docx	Form and Instruction
Attachment_4_Consent Form_Parent Caregiver Interviews Consent Form_OMB-0930-0373_12.4.19.docx Pre- and Post-Youth Survey Consent	IC Document

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
Form and Instruction	Pre- and Post-Youth Survey	Pre- and Post-Youth Survey	Attachment_3_Youth Pre-test Post-test Survey_OMB-0930-0373_12.4.19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,093

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,186	2,186
Annual IC Time Burden (Hours)	372	372
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Pre- and Post-Youth Survey Consent	Attachment_4_Consent Form_Parent Caregiver Interviews Consent Form_OMB-0930-0373_12.4.19.docx	12/04/2019

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