Information Collection

Instrument 1- Baseline Youth Survey

IC 247978 under ICR 202211-0970-003 · OMB 0970-0577.

Documents and Forms

Document Name Document Type
Follow up removed - Instrument 1 - Baseline Youth Survey_Clean.docx Other-Survey
Follow up removed - Instrument 1 - Baseline Youth Survey_Clean.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Instrument 1- Baseline Youth Survey	Agency IC Tracking Number:

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
Other-Survey			Follow up removed - Instrument 1 - Baseline Youth Survey_Clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 470	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	235	15	220
Annual IC Time Burden (Hours)	141	9	132
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.