Clinic Visit - Case Parent

Appendix F.4: Vineland
Vineland: 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)