Information Collection

[NCIPC] Caring Adults Perceptions on Teen Mental Health

IC 269870 under ICR 202507-0920-001 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-24HY [NCIPC] Caring Adults Perceptions on Teen Mental Health	Form
Form 0920-24HY Screening Survey [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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-24HY				Yes	Yes	Fillable Fileable

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 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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