Information Collection

Developmental Screener

IC 182770 under ICR 200711-0920-007 · OMB 0920-0406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0406 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 3A Developmental Screener.doc	Other-Attachment 3A Developmental Sc
Attachment 4 Ltr to Respondents.doc Attachment 4 Advance Letter to Respondents	IC Document

IC Title:

Developmental Screener

Agency IC Tracking Number:

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
Other-Attachment 3A Developmental Screener			Attachment 3A Developmental Screener.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probability Samples of the United States Population

FR Citation: 48 FR 37637

Number of Respondents: 10,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	10,100	0	0	0	0	0
Annual IC Time Burden (Hours)	505	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 4 Advance Letter to Respondents	Attachment 4 Ltr to Respondents.doc	10/30/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.