[NCIPC] Adolescent Mental Health Journey Mapping Project

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 269522

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Other-Consent/Assent Forms
Other-Consent/Assent Forms
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

[NCIPC] Adolescent Mental Health Journey Mapping Project 0920-1154-24HM
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attachment 1_Email.docx Yes Yes Fillable Fileable
Form and Instruction n/a Screening Survey and Parental Consent Attachment 2_Screening Survey.docx Yes Yes Fillable Fileable
Form and Instruction n/a LGBTQ+ Teen Screening Survey Attachment 2a_LGBTQ_Screening Survey.docx Yes Yes Fillable Fileable
Other-Consent/Assent Forms Attachment 3_Consent.AssentForms.docx Yes Yes Fillable Fileable
Form and Instruction n/a Adolescent Interview Discussion Guide Attachment 4_Adolescent Interview Discussion Guides.docx Yes Yes Fillable Fileable
Form and Instruction n/a Adolescent Focus Group Discussion Guide Attachment 5_Adolescent Focus Group Discussion Guides.docx Yes Yes Fillable Fileable
Form and Instruction n/a Adolescent Brainstorming Session Discussion Guide Attachment 6_ Adolescent Brainstorming Session Discussion Guide.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,098 0
   
Individuals or Households
 
   75 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,098 0 0 0 0 1,098
Annual IC Time Burden (Hours) 473 0 0 0 0 473
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA AMH Formative Research SSA_Teens_4.19.24_final.docx 07/19/2024
SSB AMH Formative Research SSB_Teens_4.19.24.docx 07/19/2024
PIA Attachment 7_PIA Form_AMH_06.04.24.pdf 07/19/2024
Research Determination Attachment 8_IRB Approval.pdf 07/19/2024
Screening Survey - Spanish Attachment 9_ Screening Survey Spanish.docx 07/19/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
© 2025 OMB.report | Privacy Policy