Questionaire Packets

Appendix E.11 Child Behavior Checklist
Form Approved
OMB NO. __________
Exp. Date __________

Public Reporting Burden Statement
Public reporting burden of this collection of information is estimated to average
15 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to a collection of information
unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to CDC/ATSDR
Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia
30333; ATTN: PRA (0920-XXXX)