Information Collection

Adolescent 18-19 yo Survey

IC 249761 under ICR 202110-0920-002 · OMB 0920-1362.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Adolescent 18-19 yo Survey	Form and Instruction
Adolescent Survey of Health 2021 Att 10 Adolescent Survey.docx	Form and Instruction
Adolescent Survey of Health 2021 Att 10 Adolescent Survey.docx	Form and Instruction
Att 4 TAPS Teen Survey Screenshots.docx Teen Survey Screenshots	IC Document
Att 4 TAPS Teen Survey Screenshots.docx Teen Survey Screenshots	IC Document

IC Title:

Agency IC Tracking Number:

0920-21GA

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	N/A	Adolescent Survey of Health 2021	Att 10 Adolescent Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Teen Survey Screenshots	Att 4 TAPS Teen Survey Screenshots.docx	10/15/2021

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