Information Collection

Adolescent Follow-back Survey

IC 244154 under ICR 202102-0920-005 · OMB 0920-0214.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0214 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0214 Adolescent Follow-back Survey	Form and Instruction
0920-0214 Adolescent Follow-back Survey Att 9e - 2020-2022 Adolescent Follow-back Survey (AFS) - Adolescent Questionnaire.docx	Form and Instruction
0920-0214 Adolescent Follow-back Survey Att 9e - 2020-2022 Adolescent Follow-back Survey (AFS) - Adolescent Questionnaire.docx	Form and Instruction

IC Title:

Adolescent Follow-back Survey

Agency IC Tracking Number:

0920-0214

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
Form and Instruction	0920-0214	Adolescent Follow-back Survey	Att 9e - 2020-2022 Adolescent Follow-back Survey (AFS) - Adolescent Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utilization Statistics

FR Citation: 49 FR 37693

Number of Respondents: 1,200

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	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	320	320
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.