Information Collection

Youth survey for proof-of-concept study

IC 275426 under ICR 202504-0970-016 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1a. Youth Survey (Proof of Concept).docx	Other-Survey
Instrument 1a. Youth Survey (Proof of Concept).docx	Other-Survey
SRAENE_Generic_SSA 05.20.2025.docx SSA - Umbrella Generic and Initial GenIC: Proof-of-Concept NativeSTAND	IC Document
SRAENE_Generic_SSA 05.20.2025.docx SSA - Umbrella Generic and Initial GenIC: Proof-of-Concept NativeSTAND	IC Document
SRAENE_Generic_SSB 05.20.2025.docx SSB - Umbrella Generic and Initial GenIC: Proof-of-Concept NativeSTAND	IC Document
SRAENE_Generic_SSB 05.20.2025.docx SSB - Umbrella Generic and Initial GenIC: Proof-of-Concept NativeSTAND	IC Document
Appendix A1 Proof-of-concept study consent and assent forms.docx Appendix A1: Proof-of-concept study consent and assent forms	IC Document
Appendix A1 Proof-of-concept study consent and assent forms.docx Appendix A1: Proof-of-concept study consent and assent forms	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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
Other-Survey					Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA - Umbrella Generic and Initial GenIC: Proof-of-Concept NativeSTAND		05/22/2025
SSB - Umbrella Generic and Initial GenIC: Proof-of-Concept NativeSTAND		05/22/2025
Appendix A1: Proof-of-concept study consent and assent forms		05/22/2025

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

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