Information Collection

Screener; Parental Permission Process; Consent; Main Study

IC 259672 under ICR 202304-0910-005 · OMB 0910-0919.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screener_030523.docx	Other-Screener
Screener_030523.docx	Other-Screener
Parental Permission_030323.docx	Other-Parental Permission
Parental Permission_030323.docx	Other-Parental Permission
Survey_030523.docx	Other-Survey
Survey_030523.docx	Other-Survey
Young Adult Oral Consent_030523.docx	Other-Young Adult Oral Consent
Young Adult Oral Consent_030523.docx	Other-Young Adult Oral Consent
Youth Oral Assent_030523.docx	Other-Youth Oral Assent
Youth Oral Assent_030523.docx	Other-Youth Oral Assent

IC Title:

Agency IC Tracking Number:

CTP

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Screener_030523.docx	Yes	Yes	Fillable Printable
Other-Parental Permission	Parental Permission_030323.docx	Yes	Yes	Fillable Printable
Other-Survey	Survey_030523.docx	Yes	Yes	Fillable Printable
Other-Young Adult Oral Consent	Young Adult Oral Consent_030523.docx	No		Paper Only
Other-Youth Oral Assent	Youth Oral Assent_030523.docx	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 375

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	375	375
Annual IC Time Burden (Hours)	193	193
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.