View Information Collection (IC)

View Information Collection (IC)

Cognitive Testing of Adverse Childhood Events Questions for the Youth Risk Behavior Surveillance System (YRBSS) 0920-0222-21GT
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0222 Respondent Screener Att 4 Telephone Screening Script ACES 7.6.21.docx NA No   Fillable Fileable
Form and Instruction 0920-0222 Screener Parent/Guardian Att 4 Telephone Screening Script ACES 7.6.21.docx NA No   Fillable Fileable
Other-Virtual interview Zoom/Skype set up support Att 4 Telephone Screening Script ACES 7.6.21.docx NA No   Fillable Fileable
Form and Instruction 0920-0222 Questionnaire - uestions to be Cognitively tested Att 2- Questions to be Cognitively Tested ACES 7.14.21.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0222 Respondent Data Collection Sheets - In-person/Virtual Att 6a6b Respondent Data Collection Sheets.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0222 Respondent Debriefing Interview Att 8 Respondent Debriefing Interview.docx NA Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

290 0
   
Individuals or Households
 
   75 %

  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 290 0 290 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

Title Document Date Uploaded
Procedures for Cognitive Testing Att 1 - Procedures for Cognitive Testing of ACES Questions for the YRBSS.docx 07/21/2021
Flyers Att 3a and 3b flyers.docx 07/21/2021
Informed Consent Att 5a-5d Informed Consent forms ACES.docx 07/21/2021
Thank You Letter Att 7 Thank you letter.docx 07/21/2021
Distress Guide Att 9 Distress guide.docx 07/21/2021
10 day letter 10-day letter-virtual Teen ACES-Revised CLEAN 7-29-21.docx 07/31/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.