Online Survey Email and Online Survey Screening for Parents

Youth Knowledge, Attitudes, and Feedback to Inform Choose Respect Implementation

Documents and Forms

Document Name Document Type
Attach E Online Survey Invitation Email 10-08.doc Other-WORD
Attach F Online Survey Screening Instrument for Parents REV 6-09 REV 4-28-10.doc Other-WORD

Information Collection (IC) Details

IC Title:	Online Survey Email and Online Survey Screening for Parents	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-WORD			Attach E Online Survey Invitation Email 10-08.doc		Yes	Yes	Fillable Printable
Other-WORD			Attach F Online Survey Screening Instrument for Parents REV 6-09 REV 4-28-10.doc		Yes	Yes	Fillable Printable

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	Previously Approved
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	133	133
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.