Teen Form

[NCBDDD] Documenting Outcomes Associated with Persistent Tic Disorders (Including Tourette Syndrome) in Children, Adolescents, and Young Adults Through Surveillance

Documents and Forms

Document Name Document Type
Teen Form Form and Instruction
Teen Att 5_Teen Forms.docx Form and Instruction
Teen Att 5_Teen forms.pdf Form and Instruction
Att 10_Teen Forms in REDCap.pdf Teen Redcap copy IC Document
Att 10_Teen Forms in REDCap.pdf Teen Redcap copy IC Document

Information Collection (IC) Details

IC Title:	Teen Form	Agency IC Tracking Number:	0920-24EG

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 and Instruction	n/a	Teen	Att 5_Teen forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62811

Number of Respondents: 140	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	140	140
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Teen Redcap copy	Att 10_Teen Forms in REDCap.pdf	09/22/2025

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