Information Collection

[NCIPC] Caring Adults Perceptions on Teen Mental Health

IC 269497 under ICR 202507-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1154 (24HL) ADULT MENTOR SCREENING SURVEY [NCIPC] Caring Adults Perceptions on Teen Mental Health	Form and Instruction
Form 0920-1154 (2HL) INTERVIEW DISCUSSION GUIDE [NCIPC] Caring Adults Perceptions on Teen Mental Health	Form and Instruction
Attachment 1_Email.docx	Instruction
Attachment 1_Email.docx	Instruction
Caring Adults Perceptions SSA.7.25.24.docx	Instruction
Caring Adults Perceptions SSA.7.25.24.docx	Instruction
0920-1154 (24HL) ADULT MENTOR SCREENING SURVEY Attachment 2_Screening Survey.7.25.24.docx	Form and Instruction
0920-1154 (24HL) ADULT MENTOR SCREENING SURVEY Attachment 2_Screening Survey.7.25.24.docx	Form and Instruction
0920-1154 (2HL) INTERVIEW DISCUSSION GUIDE Attachment 4_Interview Discussion Guide.docx	Form and Instruction
0920-1154 (2HL) INTERVIEW DISCUSSION GUIDE Attachment 4_Interview Discussion Guide.docx	Form and Instruction
GEN IC Request Memo.7.25.24.docx Request for Approval under the “Formative Research and Tool Development” (OMB Control Number: 0920-1154)	IC Document
GEN IC Request Memo.7.25.24.docx Request for Approval under the “Formative Research and Tool Development” (OMB Control Number: 0920-1154)	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

IC Title:

[NCIPC] Caring Adults Perceptions on Teen Mental Health

Agency IC Tracking Number:

0920-1154-24HL

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	No	Printable Only
Form and Instruction	0920-1154 (24HL)	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable Signable
Form and Instruction	0920-1154 (2HL)	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval under the âFormative Research and Tool Developmentâ (OMB Control Number: 0920-1154)		07/26/2024
SSA		07/26/2024
SSB		07/26/2024

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

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