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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation - U.S. PHSA		12/29/2025
Technical Overview of AmeriSpeak Panel		12/29/2025
Wave 3 Parent Survey - screenshots		12/29/2025
Wave 3 Young Adult Survey - screenshots		12/29/2025
Wave 3 Teen Pulse Survey - screenshots		12/29/2025
Wave 3 Parent Survey - Consent Language		12/29/2025
Wave 3 Young Adult Survey - Consent Language		12/29/2025
Wave 3 Teen Pulse Survey - Parent Consent Language and Teen Assent Language		12/29/2025
NORC - IRB Approval		12/29/2025
AmeriSpeak Recruitment/Reminder Materials		12/29/2025
GenIC Request Form		12/29/2025
Supporting Statement A		01/28/2026
Supporting Statement B		01/28/2026

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].