Youth Screener--Supplemental

The Real Cost Campaign Outcomes Evaluation Study: Cohort 3 (Outcomes Study)

Documents and Forms

Document Name Document Type
Attachment 16. Social Media_Screener_ExPECTT3_Baseline.docx Other-Social Media_Screener ExPECTT3

Information Collection (IC) Details

IC Title:	Youth Screener--Supplemental	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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-Social Media_Screener ExPECTT3 Baseline			Attachment 16. Social Media_Screener_ExPECTT3_Baseline.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	400	400
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.