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Agenda
Reg Review
ICR
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
To view an IC, click on IC Title