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YSI Program Users (Post-Use Survey)
Evaluation of the Young Sisters Initiative: A Guide to A Better You! Program
OMB: 0920-0951
IC ID: 204464
OMB.report
HHS/CDC
OMB 0920-0951
ICR 201210-0920-004
IC 204464
( )
Documents and Forms
Document Name
Document Type
YSI Program Users (Post-Use Survey)
Form
Post-Use Survey Screenshots
Att 5A_YSI Program Post-Use Survey_9 17 2012.pdf
Form
Att 5B_Full Version YSI Program Post-Use Survey_ 9 17 2012.docx
Word Version - Post-Use Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
YSI Program Users (Post-Use Survey)
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
Form
none
Post-Use Survey Screenshots
Att 5A_YSI Program Post-Use Survey_9 17 2012.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
300
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
300
0
300
0
0
0
Annual IC Time Burden (Hours)
100
0
100
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Word Version - Post-Use Survey
Att 5B_Full Version YSI Program Post-Use Survey_ 9 17 2012.docx
09/27/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.