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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Formative Research on Resilience and Transgender Youth
Agency IC Tracking Number:
0920-16BFO
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
N/A
Qualitative Interview Guide
Att 3 Qualitative InDepth Interview Guide.docx
No
Paper Only
Form and Instruction
N/A
Eligibility Screener
Att 6 Eligibility Screener.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 252
Number of Respondents:
48
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
48
0
48
0
0
0
Annual IC Time Burden (Hours)
73
0
73
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Authorizing Legislation
Att 1-Section 301 of the PHSA.PDF
10/14/2016
60-day FRN for the Generic
Att 2 60 Day FRN.PDF
10/14/2016
Consent Form for Ages 18+
Att 4a Consent Form(Age 18+).docx
10/14/2016
Assent Form for Ages 15-17
Att 4b Assent Form(Age 15-17).docx
10/14/2016
Recruitment Flyer and Palmcard Text
Att 5-Recruitment Flyer and Palmcard Text.docx
10/14/2016
Interviewer Form (for staff use only)
Att 7- Interviewer Form.docx
10/14/2016
MOU with Community Based Organizations
Att 8-Memorandum of Understanding with CBOs.docx
10/14/2016
Atlanta Metro Resources
Att 9- Atlanta Metro Resources.docx
10/14/2016
IRB Documentation for CDC and ICF
Att 10 IRB Approvals CDCICF.DOCX
10/14/2016
Supporting Statement A
SSA_10 14 2016.docx
10/14/2016
Supporting Statement B
SSB_10 14 2016.docx
10/14/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.