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View Information Collection (IC)

Mapping experiences of young adults and families impacted by adverse childhood experiences (ACEs) 0920-1154-22HQ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1154 Conversation Guide for Parents and Young Adults Attachment C_ConversationGuideParentsandYoungAdults_MappingExperiencesACEs.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Conversation Guide for Social Service Providers Attachment D_ConversationGuideSocialServiceProviders_MappingExperiencesACEs.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Virtual Focus Group Guide Attachment E_VirtualFocusGroupGuide_MappingExperiencesACEs.docx Yes Yes Fillable Fileable
Instruction Attachment A_Informed Consent Forms_MappingExperiencesACEs.docx Yes No Fillable Fileable
Form and Instruction 0920-1154 Recruitment Screener Attachment B_Recruitment Materials_MappingExperiencesACEs.docx Yes No Fillable Fileable

Health Public Health Monitoring

 

300 0
   
Individuals or Households
 
   80 %

  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 300 0 300 0 0 0
Annual IC Time Burden (Hours) 200 0 200 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PIA Attachment F_PIA Form_ACEs Mapping Project revised (lg)_final.pdf 07/21/2022
IRB determination Attachment G_CDC IRB approval.docx 07/21/2022
SSA SSA_GenIC_MappingExperiencesACEs_03_22 New_final.docx 07/21/2022
SSB SSB_GenIC_MappingExperiencesACEs_03_22_final.docx 07/21/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.