View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire	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	NA	Youth Respondent Questionnaire	Attachment J_DVACS_Youth Participant Questionnaire.pdf	NA	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: 377	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	377	0	377	0	0	0
Annual IC Time Burden (Hours)	377	0	377	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Yourh Respondent Questionnaire - Closing	Attachment J_DVACS_Closing_ Youth Participant Questionnaire_CORE QUESTIONNAIRE CLOSING.pdf	12/03/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.