Information Collection

P1. Youth Cognitive Interview GUIDE

IC 214643 under ICR 202005-0920-005 · OMB 0920-0621.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0621 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0621 P1. Youth Cognitive Interview GUIDE	Form and Instruction
0920-0621 Youth Cognitive Testing Interview Guide – Users Attachment Q1. Youth Cognitive Testing Interview Guide (Users).docx	Form and Instruction
0920-0621 Youth Cognitive Testing Interview Guide (Non-users) Attachment Q2. Youth Cognitive Testing Interview Guide (Non-users).docx	Form and Instruction

IC Title:

P1. Youth Cognitive Interview GUIDE

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	0920-0621	Youth Cognitive Testing Interview Guide â Users	Attachment Q1. Youth Cognitive Testing Interview Guide (Users).docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0621	Youth Cognitive Testing Interview Guide (Non-users)	Attachment Q2. Youth Cognitive Testing Interview Guide (Non-users).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40	-10	50
Annual IC Time Burden (Hours)	40	2	38
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.