2021-2023 Data Collection Checklist

2021 and 2023 National Youth Risk Behavior Surveys and 2021 ABES

Documents and Forms

Document Name Document Type
Form 0920-0493 2021-2023 Data Collection Checklist Form and Instruction
0920-0493 Data Collection Checklist for YRBS Att G_Data Collection Checklist.docx Form and Instruction
0920-0493 Data Collection Checklist for YRBS Att G_Data Collection Checklist.docx Form and Instruction

Information Collection (IC) Details

IC Title:	2021-2023 Data Collection Checklist	Agency IC Tracking Number:	0920-22GU

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	0920-0493	Data Collection Checklist for YRBS	Att G_Data Collection Checklist.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,360	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,360	720	640
Annual IC Time Burden (Hours)	340	180	160
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.