Information Collection

Youth Questionnaire

IC 234096 under ICR 202110-0930-004 · OMB 0930-0357.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0357 can be found here:

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

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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,000	-1,000	6,000
Annual IC Time Burden (Hours)	1,000	400	600
Annual IC Cost Burden (Dollars)	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.