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Youth Screener
Monthly Monitoring Study
OMB: 0910-0914
IC ID: 257905
OMB.report
HHS/FDA
OMB 0910-0914
ICR 202301-0910-009
IC 257905
( )
Documents and Forms
Document Name
Document Type
Attachment 1. Monthly Monitoring Study_ENDS Survey.docx
Other-Monthly Monitoring Study ENDS
Attachment 1. Monthly Monitoring Study_ENDS Survey.docx
Other-Monthly Monitoring Study ENDS
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Youth Screener
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-Monthly Monitoring Study ENDS Screener/Survey
Attachment 1. Monthly Monitoring Study_ENDS Survey.docx
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
135,000
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
135,000
0
0
135,000
0
0
Annual IC Time Burden (Hours)
5,625
0
0
5,625
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.