Youth Survey

Evaluation of the Parents Speak Up National Campaign: Youth Survey

Documents and Forms

Document Name Document Type
0990-psuncConfidentiality Certificate.pdf Other-Confidential Certificate
0990-0325-Youth Survey.doc Other-Youth Survey

Information Collection (IC) Details

IC Title:	Youth Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Confidential Certificate			0990-psuncConfidentiality Certificate.pdf		No	No	Paper Only
Other-Youth Survey			0990-0325-Youth Survey.doc		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 760	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	760	760
Annual IC Time Burden (Hours)	253	253
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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