Information Collection

Youth participant questionnaire

IC 244953 under ICR 202012-0920-010 · OMB 0920-1356.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1356 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Youth participant questionnaire	Form
Youth participant questionnaire AttachmentJ_VACS Youth Participant Questionnaire_EFtracked.docx	Form
AttachmentK_Screeneshots.pdf Questionnaire screenshots	IC Document

IC Title:

Youth participant questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	none	Youth participant questionnaire	AttachmentJ_VACS Youth Participant Questionnaire_EFtracked.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 377

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	377	377
Annual IC Time Burden (Hours)	377	377
Annual IC Cost Burden (Dollars)	10,741	10,741

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Questionnaire screenshots	AttachmentK_Screeneshots.pdf	12/21/2020

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