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[NCIPC] Caring Adults Perceptions on Teen Mental Health
[OS] CDC/ATSDR Formative Research and Tool Development
OMB: 0920-1154
IC ID: 269870
OMB.report
HHS/CDC
OMB 0920-1154
ICR 202503-0920-028
IC 269870
( )
Documents and Forms
Document Name
Document Type
Form 0920-24HY
[NCIPC] Caring Adults Perceptions on Teen Mental Health
Form
Form 0920-24HY
[NCIPC] Caring Adults Perceptions on Teen Mental Health
Form
0920-24HY Screening Survey
Attachment 2_Screening Survey.7.25.24.docx
Form
0920-24HY Screening Survey
Attachment 2_Screening Survey.7.25.24.docx
Form
Attachment 3_Adult Mentor Consent Form.7.25.24.docx
Consent Form
IC Document
Attachment 3_Adult Mentor Consent Form.7.25.24.docx
Consent Form
IC Document
Caring Adults Perceptions SSA.7.25.24.docx
SSA
IC Document
Caring Adults Perceptions SSA.7.25.24.docx
SSA
IC Document
Carig Adulst Perceptions SSB.7.25.24.docx
SSB
IC Document
Carig Adulst Perceptions SSB.7.25.24.docx
SSB
IC Document
GEN IC Request Memo.7.25.24.docx
GenIC Memo
IC Document
GEN IC Request Memo.7.25.24.docx
GenIC Memo
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[NCIPC] Caring Adults Perceptions on Teen Mental Health
Agency IC Tracking Number:
0920-24HY
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
0920-24HY
Screening Survey
Attachment 2_Screening Survey.7.25.24.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
65
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
65
0
0
0
0
65
Annual IC Time Burden (Hours)
28
0
0
0
0
28
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Consent Form
Attachment 3_Adult Mentor Consent Form.7.25.24.docx
08/06/2024
SSA
Caring Adults Perceptions SSA.7.25.24.docx
08/06/2024
SSB
Carig Adulst Perceptions SSB.7.25.24.docx
08/06/2024
GenIC Memo
GEN IC Request Memo.7.25.24.docx
08/06/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.