Information Collection

Attachment B29. Pediatric Quality of Life (young child) (Child)

IC 179852 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Attachment B29. Pediatric Quality of Life (young child) (Child)	Form and Instruction
Pediatric Quality of Life (young child) Attachment B29 Child Pediatric Quality of Life Young Child (5-7) scan.doc	Form and Instruction

IC Title:

Attachment B29. Pediatric Quality of Life (young child) (Child)

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Pediatric Quality of Life (young child)	Attachment B29 Child Pediatric Quality of Life Young Child (5-7) 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: 5

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	5	5
Annual IC Time Burden (Hours)	0	0
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.