View Information Collection (IC)
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View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NCCDPHP] Health Surveys of Teens, Young Adults, and Parents of Children and Adolescents
Agency IC Tracking Number:
0920-26-0010
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
0920-1154
Wave 3 - Parent Survey
Attachment B_Wave 3 Parent Survey.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Wave 3 - Young Adult Survey
Attachment C_Wave 3 Young Adult Survey.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Teen Pulse Survey
Attachment D_Teen Pulse Survey.docx
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:
2,800
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
2,800
0
2,800
0
0
0
Annual IC Time Burden (Hours)
1,121
0
1,121
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Authorizing Legislation - U.S. PHSA
Attachment A_Public Health Service Act (PHSA) 42 U.S.C.pdf
12/29/2025
Technical Overview of AmeriSpeak Panel
Attachment E_Technical Overview of the NORC AmeriSpeak Panel.pdf
12/29/2025
Wave 3 Parent Survey - screenshots
Attachment F_Wave 3 Parent Survey Screenshots.docx
12/29/2025
Wave 3 Young Adult Survey - screenshots
Attachment G_Wave 3 Young Adult Survey Screenshots.docx
12/29/2025
Wave 3 Teen Pulse Survey - screenshots
Attachment H_Teen Pulse Survey Screenshots.docx
12/29/2025
Wave 3 Parent Survey - Consent Language
Attachment I_Wave 3 Parent Survey Consent Language.docx
12/29/2025
Wave 3 Young Adult Survey - Consent Language
Attachment J_Wave 3 Young Adult Survey Consent Language.docx
12/29/2025
Wave 3 Teen Pulse Survey - Parent Consent Language and Teen Assent Language
Attachment K_Teen Pulse Survey Parent Consent Language and Teen Assent Language.docx
12/29/2025
NORC - IRB Approval
Attachment L_NORC Institutional Review Board Approval Letter for Survey Protocols.pdf
12/29/2025
AmeriSpeak Recruitment/Reminder Materials
Attachment M_Sample AmeriSpeak Recruitment and Reminder Materials.docx
12/29/2025
GenIC Request Form
Gen IC Request Form.docx
12/29/2025
Supporting Statement A
SSA.docx
01/28/2026
Supporting Statement B
SSB.docx
01/28/2026
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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