Information Collection

Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire

IC 250663 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⚠️ Notice: This information collection may be referencing outdated material.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:

2022-08-11 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Youth Respondent Questionnaire Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire	Form and Instruction
Youth Respondent Questionnaire Attachment J_DVACS_Youth Participant Questionnaire.pdf	Form and Instruction
Attachment J_DVACS_Closing_ Youth Participant Questionnaire_CORE QUESTIONNAIRE CLOSING.pdf Yourh Respondent Questionnaire - Closing	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent 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 and Instruction	NA			NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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
	Approved	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)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Yourh Respondent Questionnaire - Closing		12/03/2021

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

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