Information Collection

Adolescent Follow-back Survey

IC 244154 under ICR 202111-0920-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.