Information Collection

Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent

IC 250644 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⚠️ Notice: This information collection may be referencing outdated material.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
Cognitive interviewing consent/assent Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent	Form and Instruction
Cognitive interviewing consent/assent Attachment F.1_Cognitive Interviewing Respondent Consent.docx	Form and Instruction

IC Title:

Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent

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 and Instruction	NA			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11	11
Annual IC Time Burden (Hours)	1	1
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.

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