View Information Collection (IC)
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View Information Collection (IC)
View Information Collection (IC)
IC Title:
Pre- and Post-Youth Survey
Agency IC Tracking Number:
Is this a Common Form?
No
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
Youth Pre-test Post-test Survey
Youth Pre-test Post-test Survey
3_Youth Pre-test Post-test Survey_January 20 2017.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:
FR Citation:
Number of Respondents:
1,093
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
2,186
0
2,186
0
0
0
Annual IC Time Burden (Hours)
372
0
372
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Youth Survey Parent Permission and Opt-Out Forms
4_Youth Survey Parent Permission and Opt-Out Forms_January 20 2017.docx
01/30/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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