Clinic Visit - Case Child

Appendix G.2: Mullen
Mullen: OMB Coversheet

Form Approved
OMB NO. __________
Exp. Date __________

Public Reporting Burden Statement
Public reporting burden of this collection of information is estimated to average 45 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)