Information Collection

Parent Component

IC 178744 under ICR 200702-0970-001 · OMB 0970-0276.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OMB HtE RI Physiology_Appendix_1-10-07.doc	Instruction
RI_Parent Consent Form_FINAL_062907.doc	Other-Parent Consent Form
RI_Parent Consent Form- Physio_FINAL_062907.doc	Other-Parent Consent: Physio

IC Title:

Parent Component

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	OMB HtE RI Physiology_Appendix_1-10-07.doc	No	No	Paper Only
Other-Parent Consent Form	RI_Parent Consent Form_FINAL_062907.doc	No		Paper Only
Other-Parent Consent: Physio	RI_Parent Consent Form- Physio_FINAL_062907.doc	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.