Information Collection

Youth Outcome Survey

IC 248671 under ICR 202201-0990-002 · OMB 0990-0480.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0480 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1_Youth Outcome Survey_CLEANrev.docx	Other-survey and instruction
Instrument 1_Youth Outcome Survey_CLEANrev.docx	Other-survey and instruction

IC Title:

Youth Outcome Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-survey and instruction			Instrument 1_Youth Outcome Survey_CLEANrev.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 498

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	1,494	1,494
Annual IC Time Burden (Hours)	996	996
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.