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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitive Testing of Occupational Safety and Health Questions for the Youth Risk Behavior Surveillance System (YRBSS) [with incentive level test]
Agency IC Tracking Number:
0920-21FZ
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
n/a
Telephone Screening Script (for Target Respondents)
Attachment 4 Telephone Screening Script CLEAN - Revised.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Telephone Screening Script (for Parent / Guardian)
Attachment 4 Telephone Screening Script CLEAN - Revised.docx
Yes
Yes
Fillable Fileable
Other-Virtual Interview Setup Support [see Sections III and IV]
Attachment 1 - Procedures for Cognitive Testing of Occupational Safety and Health Questions for the YRBSS CLEAN Revised.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Questions to be Cognitively Tested
Attachment 2- Questions to be Cognitively Tested CLEAN Revised.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Respondent Data Collection Sheet
Attachment 6 -Adult Data Collection Sheet .docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Follow-up Debriefing Discussion
Attachment 8 Follow-up Discussion_.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0164, Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population
FR Citation:
49 FR 37693
Number of Respondents:
150
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
150
0
150
0
0
0
Annual IC Time Burden (Hours)
71
0
71
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Procedures for Cognitive Testing of Occupational Health and Safety Questions for YRBSS
Attachment 1 - Procedures for Cognitive Testing of Occupational Safety and Health Questions for the YRBSS CLEAN Revised.docx
06/23/2021
Recruitment Materials
Attachment 3a-3d LettersAdFlyer_vcb042021 .docx
06/23/2021
Informed Consent Materials - Youth Assent and Parent/Guardian Permission
Attachment 5a-5f Informed Consent CLEAN.docx
06/23/2021
Thank You Letter
Attachment 7 – Thank You Letter.docx
06/23/2021
Guidance to Interviewers: Identifying, Managing, and Reporting Respondent Distress
Attachment 9 - Distress guidance.docx
06/23/2021
10 day letter
10-day letter-virtual Occupational Safety and Health Questions for the YRBSS Revised CLEAN July 29 2021.docx
07/31/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.