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Evaluation of Adolescent Pregnancy Prevention Approaches Household (Modified PPA) Survey
Outcome Evaluation of "Teenage Pregnancy Prevention:Intergrating Services, Programs, and Strategies through Community-Wide Intitatives"
OMB: 0990-0389
IC ID: 199830
OMB.report
HHS/HHSDM
OMB 0990-0389
ICR 201110-0990-004
IC 199830
( )
Documents and Forms
Document Name
Document Type
0990-TPP Evaluation Attachment C_Baseline Instrument.docx
Other-survey
0990-TPP evaluation Attachment F_young adult consent.docx
0990-TPP evaluation Attachment F_young adult consent
IC Document
0990-TPP evaluation Attachment G_household notification.docx
0990-TPP evaluation Attachment G_household notification
IC Document
0990-TPP evaluation Attachment E_youth assent.docx
0990-TPP evaluation Attachment E_youth assent
IC Document
0990-TPP evaluation Attachment D_parental consent.docx
0990-TPP evaluation Attachment D_parental consent
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Evaluation of Adolescent Pregnancy Prevention Approaches Household (Modified PPA) Survey
Agency IC Tracking Number:
Is this a Common Form?
No
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
Other-survey
0990-TPP Evaluation Attachment C_Baseline Instrument.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
6,000
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
6,000
0
6,000
0
0
0
Annual IC Time Burden (Hours)
4,500
0
4,500
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0990-TPP evaluation Attachment F_young adult consent
0990-TPP evaluation Attachment F_young adult consent.docx
10/21/2011
0990-TPP evaluation Attachment G_household notification
0990-TPP evaluation Attachment G_household notification.docx
10/21/2011
0990-TPP evaluation Attachment E_youth assent
0990-TPP evaluation Attachment E_youth assent.docx
10/21/2011
0990-TPP evaluation Attachment D_parental consent
0990-TPP evaluation Attachment D_parental consent.docx
10/21/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.