Information Collection

Youth Survey--Supplemental: Baseline & Follow-up 1,2,3

IC 257764 under ICR 202212-0910-013 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 9. Youth Survey ExPECTT 3_Baseline.docx	Other-ENGLISH Youth Survey ExPECTT 3
Attachment 9. Youth Survey ExPECTT 3_Baseline.docx	Other-ENGLISH Youth Survey ExPECTT 3
Attachment 9. Youth Survey ExPECTT 3_Baseline_SPA_DRAFT_Clean.docx	Other-SPANISH Youth Survey ExPECTT 3
Attachment 9. Youth Survey ExPECTT 3_Baseline_SPA_DRAFT_Clean.docx	Other-SPANISH Youth Survey ExPECTT 3

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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-ENGLISH Youth Survey ExPECTT 3 Baseline			Attachment 9. Youth Survey ExPECTT 3_Baseline.docx		Yes	Yes	Fillable Printable
Other-SPANISH Youth Survey ExPECTT 3_Baseline			Attachment 9. Youth Survey ExPECTT 3_Baseline_SPA_DRAFT_Clean.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,428

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	4,428	4,428
Annual IC Time Burden (Hours)	2,214	2,214
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.