Baseline Survey of impact study participants

Pregnancy Assistance Fund Feasibility And Design Study(Positive Adolescent Futures)

Documents and Forms

Document Name Document Type
0990-0424Attachment G_PAF Follow up Pretest Memorandum.docx Other-baseline survey
0990_Attachment G_Baseline Pretest Memo.pdf Attachment G Baseline Pretest Memo IC Document
0990_Attachment I_Persons Consulted.docx Attachment I Person Consulted on Instrument IC Document
0990-Attachment K_Confidentiality Pledge.pdf Attachment K Confidential Pledge IC Document
0990-Attachment M_Overview for Grantees.pdf Attachment M Overview For Grantees IC Document
0990-Attachment J_PAF_Consent Letters and Forms and Youth Assent Form_08262014.docx Consent Letters and Forms, Youth Assent Form, and Contact Information Sheet IC Document
0990-Attachment L_PAF Analysis Plan for Impact Study_revised.docx Analysis Plan for PAF Impact Study IC Document

Information Collection (IC) Details

IC Title:	Baseline Survey of impact study participants	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-baseline survey			0990-0424Attachment G_PAF Follow up Pretest Memorandum.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 673	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Previously Approved
Annual Number of Responses for this IC	673	673
Annual IC Time Burden (Hours)	337	337
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment G Baseline Pretest Memo	0990_Attachment G_Baseline Pretest Memo.pdf	06/25/2014
Attachment I Person Consulted on Instrument	0990_Attachment I_Persons Consulted.docx	06/25/2014
Attachment K Confidential Pledge	0990-Attachment K_Confidentiality Pledge.pdf	06/25/2014
Attachment M Overview For Grantees	0990-Attachment M_Overview for Grantees.pdf	06/25/2014
Consent Letters and Forms, Youth Assent Form, and Contact Information Sheet	0990-Attachment J_PAF_Consent Letters and Forms and Youth Assent Form_08262014.docx	08/29/2014
Analysis Plan for PAF Impact Study	0990-Attachment L_PAF Analysis Plan for Impact Study_revised.docx	08/29/2014

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