Information Collection

Attachment B16. Pediatric Quality of Life (teen) (Parent)

IC 179839 under ICR 200704-0920-003 · OMB 0920-0747.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0747 can be found here:

Documents and Forms

Document Name Document Type
Attachment B16. Pediatric Quality of Life (teen) (Parent) Form and Instruction
Pediatric Quality of Life (teen) Attachment B16 Parent Pediatric Quality of Life Teen (13-18) scan.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment B16. Pediatric Quality of Life (teen) (Parent)	Agency IC Tracking Number:

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	None	Pediatric Quality of Life (teen)	Attachment B16 Parent Pediatric Quality of Life Teen (13-18) scan.doc		No	No	Paper Only

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 62812

Number of Respondents: 536	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,072	1,072
Annual IC Time Burden (Hours)	71	71
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.