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Youth Questionnaire
Monitoring Data Collection Tools for the Minority AIDS Initiative (MAI)
OMB: 0930-0357
IC ID: 234096
OMB.report
HHS/SAMHSA
OMB 0930-0357
ICR 202110-0930-004
IC 234096
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0357 can be found here:
2024-06-24 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form MAI Youth Question
Youth Questionnaire
Form and Instruction
MAI Youth Question MAI Youth Questionnaire 2021
MAI_Youth Questionnaire 2021_CLEAN.docx
Form and Instruction
MAI Youth Question MAI Youth Questionnaire 2021
MAI_Youth Questionnaire 2021_CLEAN.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Youth Questionnaire
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
MAI Youth Questionnaire 2021
MAI Youth Questionnaire 2021
MAI_Youth Questionnaire 2021_CLEAN.docx
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:
2,500
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
5,000
0
-1,000
0
0
6,000
Annual IC Time Burden (Hours)
1,000
0
400
0
0
600
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.