Information Collection

Background Information Form (Previously titled Young Adult Baseline Survey)

IC 189105 under ICR 202007-0970-013 · OMB 0970-0383.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
C_Young Adult Background Information Form_071620_clean_for OMB.docx	Other-Survey
Memo_TLP YOS_NonSub Change Request_final_071620.docx Memo - NonSub Change - COVID-19	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
Other-Survey			C_Young Adult Background Information Form_071620_clean_for OMB.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	400	200	200
Annual IC Time Burden (Hours)	112	-12	124
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo - NonSub Change - COVID-19	Memo_TLP YOS_NonSub Change Request_final_071620.docx	07/24/2020

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