Information Collection

Youth Engagement Exit Ticket

IC 248667 under ICR 202207-0990-004 · OMB 0990-0480.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 3_Youth Engagement Exit Ticket.docx	Other-exit ticket survey and instruc
Instrument 3_Youth Engagement Exit Ticket.docx	Other-exit ticket survey and instruc

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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-exit ticket survey and instruction			Instrument 3_Youth Engagement Exit Ticket.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 533

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,396	6,396
Annual IC Time Burden (Hours)	213	213
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.