Information Collection

Teen Phone Screener

IC 264293 under ICR 202501-0925-002 · OMB 0925-0781.

Documents and Forms

Document Name Document Type
Form 1 Teen Phone Screener Form
1 Screener Att D - Teen Phone Screener - Revised Sept 2024.docx Form
1 Screener Att D - Teen Phone Screener - Revised Sept 2024.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Teen Phone Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form	1	Screener	Att D - Teen Phone Screener - Revised Sept 2024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 72	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	6	6
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.