Youth Screener

Monthly Monitoring Study

Documents and Forms

Document Name Document Type
Attachment 1. Monthly Monitoring Study_ENDS Survey.docx Other-Monthly Monitoring Study ENDS
Attachment 1. Monthly Monitoring Study_ENDS Survey.docx Other-Monthly Monitoring Study ENDS

Information Collection (IC) Details

IC Title:	Youth Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-Monthly Monitoring Study ENDS Screener/Survey			Attachment 1. Monthly Monitoring Study_ENDS Survey.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 135,000	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
Annual Number of Responses for this IC	135,000	135,000
Annual IC Time Burden (Hours)	5,625	5,625
Annual IC Cost Burden (Dollars)	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.