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Children's Wave Survey 2
Evaluation of the Parents Speak Up National Campaign: Youth Survey
OMB: 0990-0325
IC ID: 188672
OMB.report
HHS/HHSDM
OMB 0990-0325
ICR 200904-0990-001
IC 188672
( )
Documents and Forms
Document Name
Document Type
0990-psuncConfidentiality Certificate.pdf
Other-Confidential Certificate
0990-0325Parents Speak Up National Campaign Children's Survey.doc
Other-survey
0990-PSUNCParent E-mail Notification and Consent.doc
Other-notification
0990-0325PSUNCTeen Assent Form.doc
Other-consent form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Children's Wave Survey 2
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-Confidential Certificate
0990-psuncConfidentiality Certificate.pdf
No
No
Paper Only
Other-survey
0990-0325Parents Speak Up National Campaign Children's Survey.doc
No
No
Printable Only
Other-notification
0990-PSUNCParent E-mail Notification and Consent.doc
Yes
Yes
Paper Only
Other-consent form
0990-0325PSUNCTeen Assent Form.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
400
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
400
0
400
0
0
0
Annual IC Time Burden (Hours)
133
0
133
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.