Youth Outcome Survey

Components Study of REAL Essentials

Documents and Forms

Document Name Document Type
Instrument 1_Youth Outcome Survey_CLEANrev.docx Other-survey and instruction
Instrument 1_Youth Outcome Survey_CLEANrev.docx Other-survey and instruction

Information Collection (IC) Details

IC Title:	Youth Outcome Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 and instruction			Instrument 1_Youth Outcome Survey_CLEANrev.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 498	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,494	1,494
Annual IC Time Burden (Hours)	996	996
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.