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PATH/Baseline- Adults - Followup/Tracking Participant Information Form for Youth (completed by parents)
Population Assessment of Tobacco and Health (PATH) Study (NIDA)
OMB: 0925-0664
IC ID: 203763
OMB.report
HHS/NIH
OMB 0925-0664
ICR 201407-0925-004
IC 203763
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0664 can be found here:
2016-07-05 - Revision of a currently approved collection
2015-10-07 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
PATH/Baseline- Adults - Followup/Tracking Participant Information Form for Youth (completed by parents)
Form and Instruction
1 Follow-up/Tracking Participant Information Form (complet
3i-English. Followup Tracking Participant Information Form - Youth 050813.pdf
Form and Instruction
3i-Spanish. Followup Tracking Participant Information Form - Youth.pdf
3i-Spanish
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PATH/Baseline- Adults - Followup/Tracking Participant Information Form for Youth (completed by parents)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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
1
Follow-up/Tracking Participant Information Form (completed by parents)
3i-English. Followup Tracking Participant Information Form - Youth 050813.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
NIH Privacy Act System of Records 09-25-0200 Clinical, Basic Population-based research studies of NIH, HHS/NIH/OD
FR Citation:
67 FR 60741
Number of Respondents:
16,186
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
0
0
-32,372
0
0
32,372
Annual IC Time Burden (Hours)
0
0
-4,316
0
0
4,316
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
3i-Spanish
3i-Spanish. Followup Tracking Participant Information Form - Youth.pdf
06/28/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.