Youth Survey

Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs

Documents and Forms

Document Name Document Type
Youth Survey Form
Youth Survey Att 9B_YouthSurvey.docx Form
Youth Survey - Spanish Att 9B-S_YouthSurvey_SP.docx Form
Att 9C_Youth_CaregiverSurvey_ItemSources_2013_0618.pdf Att 9C_Youth_CaregiverSurvey_ItemSources_2013_0618 IC Document

Information Collection (IC) Details

IC Title:	Youth Survey	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
Form	none	Youth Survey	Att 9B_YouthSurvey.docx		Yes	Yes	Fillable Fileable
Form	none	Youth Survey - Spanish	Att 9B-S_YouthSurvey_SP.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 640	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	640	640
Annual IC Time Burden (Hours)	213	213
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 9C_Youth_CaregiverSurvey_ItemSources_2013_0618	Att 9C_Youth_CaregiverSurvey_ItemSources_2013_0618.pdf	08/06/2013

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