Information Collection

[NCCDPHP] Health Surveys of Teens, Young Adults, and Parents of Children and Adolescents

IC 278573 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⚠️ Notice: This information collection may be referencing outdated material.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:

2026-01-29 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Form 0920-1154 Wave 3 - Parent Survey [NCCDPHP] Health Surveys of Teens, Young Adults, and Parents of Children and Adolescents Form and Instruction
Form 0920-1154 Wave 3 - Young Adult Survey [NCCDPHP] Health Surveys of Teens, Young Adults, and Parents of Children and Adolescents Form and Instruction
Form 0920-1154 Teen Pulse Survey [NCCDPHP] Health Surveys of Teens, Young Adults, and Parents of Children and Adolescents Form and Instruction
0920-1154 Wave 3 - Parent Survey Attachment B_Wave 3 Parent Survey.docx Form and Instruction
0920-1154 Wave 3 - Young Adult Survey Attachment C_Wave 3 Young Adult Survey.docx Form and Instruction
0920-1154 Teen Pulse Survey Attachment D_Teen Pulse Survey.docx Form and Instruction
Attachment A_Public Health Service Act (PHSA) 42 U.S.C.pdf Authorizing Legislation - U.S. PHSA IC Document
Attachment E_Technical Overview of the NORC AmeriSpeak Panel.pdf Technical Overview of AmeriSpeak Panel IC Document
Attachment F_Wave 3 Parent Survey Screenshots.docx Wave 3 Parent Survey - screenshots IC Document
Attachment G_Wave 3 Young Adult Survey Screenshots.docx Wave 3 Young Adult Survey - screenshots IC Document
Attachment H_Teen Pulse Survey Screenshots.docx Wave 3 Teen Pulse Survey - screenshots IC Document
Attachment I_Wave 3 Parent Survey Consent Language.docx Wave 3 Parent Survey - Consent Language IC Document
Attachment J_Wave 3 Young Adult Survey Consent Language.docx Wave 3 Young Adult Survey - Consent Language IC Document
Attachment K_Teen Pulse Survey Parent Consent Language and Teen Assent Language.docx Wave 3 Teen Pulse Survey - Parent Consent Language and Teen Assent Language IC Document
Attachment L_NORC Institutional Review Board Approval Letter for Survey Protocols.pdf NORC - IRB Approval IC Document
Attachment M_Sample AmeriSpeak Recruitment and Reminder Materials.docx AmeriSpeak Recruitment/Reminder Materials IC Document
Gen IC Request Form.docx GenIC Request Form IC Document
SSA.docx Supporting Statement A IC Document
SSB.docx Supporting Statement B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCCDPHP] Health Surveys of Teens, Young Adults, and Parents of Children and Adolescents	Agency IC Tracking Number:	0920-26-0010

IC Status: New

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 and Instruction	0920-1154	Wave 3 - Parent Survey	Attachment B_Wave 3 Parent Survey.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Wave 3 - Young Adult Survey	Attachment C_Wave 3 Young Adult Survey.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Teen Pulse Survey	Attachment D_Teen Pulse Survey.docx	NA	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: 2,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,800	2,800
Annual IC Time Burden (Hours)	1,121	1,121
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Authorizing Legislation - U.S. PHSA	Attachment A_Public Health Service Act (PHSA) 42 U.S.C.pdf	12/29/2025
Technical Overview of AmeriSpeak Panel	Attachment E_Technical Overview of the NORC AmeriSpeak Panel.pdf	12/29/2025
Wave 3 Parent Survey - screenshots	Attachment F_Wave 3 Parent Survey Screenshots.docx	12/29/2025
Wave 3 Young Adult Survey - screenshots	Attachment G_Wave 3 Young Adult Survey Screenshots.docx	12/29/2025
Wave 3 Teen Pulse Survey - screenshots	Attachment H_Teen Pulse Survey Screenshots.docx	12/29/2025
Wave 3 Parent Survey - Consent Language	Attachment I_Wave 3 Parent Survey Consent Language.docx	12/29/2025
Wave 3 Young Adult Survey - Consent Language	Attachment J_Wave 3 Young Adult Survey Consent Language.docx	12/29/2025
Wave 3 Teen Pulse Survey - Parent Consent Language and Teen Assent Language	Attachment K_Teen Pulse Survey Parent Consent Language and Teen Assent Language.docx	12/29/2025
NORC - IRB Approval	Attachment L_NORC Institutional Review Board Approval Letter for Survey Protocols.pdf	12/29/2025
AmeriSpeak Recruitment/Reminder Materials	Attachment M_Sample AmeriSpeak Recruitment and Reminder Materials.docx	12/29/2025
GenIC Request Form	Gen IC Request Form.docx	12/29/2025
Supporting Statement A	SSA.docx	01/28/2026
Supporting Statement B	SSB.docx	01/28/2026

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

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