Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire

Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US

Documents and Forms

Document Name Document Type
Form 0920-22HW Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire Form and Instruction
0920-22HW DVACS Youth Participant Questionnaire Attachment J_DVACS_Youth Participant Questionnaire.pdf Form and Instruction
0920-22HW DVACS Youth Participant Questionnaire Attachment J_DVACS_Youth Participant Questionnaire.pdf Form and Instruction
Attachment J_DVACS_Closing_ Youth Participant Questionnaire_CORE QUESTIONNAIRE CLOSING.pdf Yourh Respondent Questionnaire - Closing IC Document
Attachment J_DVACS_Closing_ Youth Participant Questionnaire_CORE QUESTIONNAIRE CLOSING.pdf Yourh Respondent Questionnaire - Closing IC Document

Information Collection (IC) Details

IC Title:	Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire	Agency IC Tracking Number:	0920-22HW

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	0920-22HW	DVACS Youth Participant Questionnaire	Attachment J_DVACS_Youth Participant Questionnaire.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 377	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	377	377
Annual IC Time Burden (Hours)	377	377
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Yourh Respondent Questionnaire - Closing	Attachment J_DVACS_Closing_ Youth Participant Questionnaire_CORE QUESTIONNAIRE CLOSING.pdf	12/03/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.