Information Collection

Youth

IC 178435 under ICR 202311-0930-002 · OMB 0930-0286.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Youth Outcomes and Youth	Form and Instruction
Form Youth Outcomes and Youth Outcomes and Resiliency Survey (YORS) Youth	Form and Instruction
Form Youth Experience R Youth Experience Reflective Journal (YERJ) Youth	Form and Instruction
Youth Outcomes and Youth Outcomes and Resiliency Survey (YORS) Att I. YORS_for OMB 7_24_23 final.docx	Form and Instruction
Youth Outcomes and Youth Outcomes and Resiliency Survey (YORS) Att I. YORS_for OMB 7_24_23 final.docx	Form and Instruction
Youth Experience R Youth Experience Reflective Journal (YERJ) Att J. YERJ_for OMB 7_24_23 final.docx	Form and Instruction
Youth Experience R Youth Experience Reflective Journal (YERJ) Att J. YERJ_for OMB 7_24_23 final.docx	Form and Instruction
Att F-2. TUP-S Campus Consent to Contact Form Dec2015.docx TUP-S Campus Consent to Contact Form	IC Document
Att F-2. TUP-S Campus Consent to Contact Form Dec2015.docx TUP-S Campus Consent to Contact Form	IC Document

IC Title:

Youth

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	Youth Outcomes and Resiliency Survey (YORS)	Youth Outcomes and Resiliency Survey (YORS)	Att I. YORS_for OMB 7_24_23 final.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Youth Experience Reflective Journal (YERJ)	Youth Experience Reflective Journal (YERJ)	Att J. YERJ_for OMB 7_24_23 final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 872

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	997	997
Annual IC Time Burden (Hours)	461	461
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
TUP-S Campus Consent to Contact Form	Att F-2. TUP-S Campus Consent to Contact Form Dec2015.docx	12/23/2015

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