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[NCHHSTP] DASH Demo: Sexual Health Services Telehealth Demonstration 0920-1235-23DW
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1235 El Rio Teen TeleHealth Student Survey Att 3_Student Survey_2.28.2023.pdf N/A No   Paper Only
Form and Instruction 0920-1235 El Rio Teen TeleHealth Student Survey_Spanish Att 3a_Student Survey_SPANISH_2.28.2023.pdf N/A No   Paper Only

Health Health Care Services

 

650 0
   
Individuals or Households
 
   0 %

  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 650 0 650 0 0 0
Annual IC Time Burden (Hours) 108 0 108 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Authorizing Legislation - U.S. PHSA Att 1_Auth Legislation.pdf 08/15/2023
Parental Consent Att 4_Parental Consent Form.pdf 08/15/2023
Student Assent - Under 18 Att 5_Student Assent, under 18.pdf 08/15/2023
Student Assent - Under 18 (Spanish) Att 5a_Student Assent, under 18_SPANISH.pdf 08/15/2023
Student Consent - 18 and Up Att 6_Student Consent, 18 and up.pdf 08/15/2023
Recruitment Flyer Att 7_Recruitment Flyer.pdf 08/15/2023
IRB Approval Letter Att 8_ICF IRB Approval Letter.pdf 08/15/2023
Respondent Universe Att 9_Respondent Universe_CR LER.docx 08/15/2023
Privacy Impact Assessment (PIA) Att 10 PIA Form.pdf 08/15/2023
Supporting Statement A SSA Form_SHS Telehealth Student Survey.docx 08/17/2023
Supporting Statement B SSB Form_SHS Telehealth Student Survey.docx 08/17/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.