Information Collection

Children's Heart Health Promotion Tracker

IC 191375 under ICR 200911-0925-006 · OMB 0925-0609.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Screener Children's Heart Health Promotion Tracker	Form and Instruction
Form 1 Survey Children's Heart Health Promotion Tracker	Form and Instruction
2 Screener NHLBI Attachment 4 - Screener Instrument.docx	Form and Instruction
1 Survey NHLBI Attachment 1 - Survey Instrument.docx	Form and Instruction

IC Title:

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	2				Yes	Yes	Paper Only
Form and Instruction	1				Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,175

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,175	1,175
Annual IC Time Burden (Hours)	196	196
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.

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