Information Collection

Youth - Screener

IC 236205 under ICR 202009-0910-007 · OMB 0910-0880.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix O HPHC2 Online Survey Parent-Youth Invitation_CLEAN.docx	Other-Parent-Youth Invitation Email
Appendix I HPHC2 Online Survey Youth Assent Form_CLEAN.docx	Other-Online Survey Youth Assent For

IC Title:

Youth - Screener

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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-Parent-Youth Invitation Email			Appendix O HPHC2 Online Survey Parent-Youth Invitation_CLEAN.docx		Yes	Yes	Fillable Fileable Signable
Other-Online Survey Youth Assent Form			Appendix I HPHC2 Online Survey Youth Assent Form_CLEAN.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: 6,000

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	6,000	6,000
Annual IC Time Burden (Hours)	300	300
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.