Information Collection

[NCIPC] Caring Adults Perceptions on Teen Mental Health

IC 269497 under ICR 202507-0920-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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 (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
Caring Adults Perceptions SSA.7.25.24.docx SSA	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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