Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Household Questionnaire New 632 158 0 Form and Instruction NA Head of Household Questionnaire
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Invitation Letter New 3121 104 0 Form NA Invitation Letter
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Houehold Consent New 702 23 0 Form and Instruction NA Head of Household Consent
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Screener Questionnaire New 2808 140 0 Form and Instruction NA Screener Questionnaire
Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening New 25 4 0 Form and Instruction NA Cognitive interview screening
Pre-Test 1 (Parents of youth ages 13-17) Cognitive interview response to flyer/ telephone inquiry New 50 4 0 Form and Instruction NA Cognitive interview response to flyer/ telephone inquiry
Pre-Test 1 (Parents of youth ages 13-17) Informed Parental Consent New 6 1 0 Form and Instruction NA Informed parental consent
Pre-Test 1 (Youth ages 13-24) Cognitive Interview Protocol New 10 20 0 Form and Instruction NA Cognitive Interview Protocol
Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent New 11 1 0 Form and Instruction NA Cognitive interviewing consent/assent
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview response to flyer/ telephone inquiry New 50 4 0 Form and Instruction NA Cognitive interview response to flyer/ telephone inquiry
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview screening New 25 4 0 Form and Instruction NA Cognitive interview screening
Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Consent/Assent New 632 32 0 Form and Instruction NA Youth Respondent Consent/Assent
Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire New 377 377 0 Form and Instruction NA Youth Respondent Questionnaire
Total burden requested under this ICR: 8449 872 0  
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